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Ramazan F, Graham Y, Hayes C. Communities of practice: An alternative approach to bridging the theory-practice gap in radiography? Radiography (Lond) 2024; 30:1167-1172. [PMID: 38870692 DOI: 10.1016/j.radi.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES There is an increasing need to engage with evidence-based practice (EBP) and continuing professional development (CPD) to effectively respond to the current healthcare demands and challenges. This review critically synthesises key knowledge diffusion and implementation theories, with particular emphasis on Communities of Practice (CoPs), a theory as yet unexplored in radiography practice. KEY FINDINGS Prominent theories including implementation science, translational science and knowledge diffusion theories have previously been proposed to bridge the theory-practice gap. However, the radiography profession is a fast-paced, complex and a highly regulated profession which makes the application of rigid theories more challenging. CoPs, which have their origins in Social Learning Theory, represents a potentially more viable approach to bridging the theory-practice gap. CONCLUSION Cultivating and maintaining CoPs is a more practical approach to improve knowledge dissemination, EBP and CPD, allowing radiographers in practice to share knowledge, best practices, and experiences out with an organisational hierarchy. The collective pool of knowledge, and history created may contribute to further establishing the radiography profession and the radiographer identity as the CoPs connect, expand, and advance over time. IMPLICATIONS FOR PRACTICE CoPs may be cultivated and further investigated in radiography practice to improve knowledge dissemination, EBP and CPD, with the ultimate aim of improving individual and organisational performance in radiography practices.
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Affiliation(s)
- F Ramazan
- Alliance Medical Ltd, University Hospital of North Tees, Stockton-on-Tees, TS19 8PE, United Kingdom; Helen McArdle Nursing and Care Research Institute, University of Sunderland, Faculty of Health Sciences and Wellbeing, Silksworth Row, Sunderland, SR1 3SD, United Kingdom.
| | - Y Graham
- Helen McArdle Nursing and Care Research Institute, University of Sunderland, Faculty of Health Sciences and Wellbeing, Silksworth Row, Sunderland, SR1 3SD, United Kingdom; Faculty of Psychology, University of Anahuac Mexico, Mexico City Mexico; Faculty of Biomedical Sciences, Austral University, Pilar, Buenos Aires, Argentina.
| | - C Hayes
- University of Sunderland, Faculty of Health Sciences and Wellbeing, The John Dawson Sciences Complex, City Campus, SR1 3SD, United Kingdom.
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Brooks CF, Lund S, Kryl D, Lloyd Jones S, Myall M. "We all see things through a different lens based on our life experiences": co-production of a web-based implementation toolkit with stakeholders across the health and social care system. FRONTIERS IN HEALTH SERVICES 2024; 4:1356961. [PMID: 38812599 PMCID: PMC11133535 DOI: 10.3389/frhs.2024.1356961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/21/2024] [Indexed: 05/31/2024]
Abstract
Background Implementing new innovations across the health and social care system is complex, involving many factors that in recent years have been compounded by Covid-19. While a plethora of implementation tools and frameworks are available, there are limitations in terms of their design and accessibility. Co-production is a valuable mechanism for developing tools that have utility and accessibility for those tasked with using them in health and social care organisations and there is growing acknowledgement of increasing the role of co-production in implementation science. This paper provides novel insight into co-production practices and relevance to implementation science by reporting findings from a study to co-produce a web-based implementation toolkit (WIT) that is accessible, usable and designed to support adaptive implementation across health and social care systems. Key themes relating to the process of co-production are outlined and the value of using co-production in implementation processes are discussed. Methods A web-based survey (n = 36) was conducted with a range of stakeholders across health and social care. Findings identified a need for WIT. Survey respondents were invited to express interest in becoming part of a co-production group and to take part in three online interactive workshops to co-produce WIT. Workshops took place with the group (n = 12) and focused on key developmental stages of WIT. Results Online co-production workshops were integral to the development and refinement of WIT. Benefits of using this process identified three interrelated themes: (i) Co-designing key features of the toolkit, (ii) Co-producing a toolkit with utility for users across health and social care settings, (iii) Co-producing a toolkit to support the implementation journey. Our approach of undertaking co-production as a dialogic process enabled generation of these themes. To illuminate discussion of these themes we draw upon iterative co-development of the "active ingredients" of key components (e.g., interactive Implementation Wheel) and functions (e.g., interactive "pop-up" definitions of keyword) and features (e.g., case studies) of WIT. Conclusion Using a co-production approach with a range of end-users across health and social care systems, highlights the benefits of understanding implementation processes for users in these settings. User-centred design and processes for ensuring accessibility readily support the translation of implementation into rapidly changing health and social care systems to benefit outcomes for patients, their families, carers, service users and practitioners.
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Affiliation(s)
- Cindy Faith Brooks
- National Institute for Health and Care Research Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Susi Lund
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - David Kryl
- The Centre for Effective Services, Dublin, Ireland
| | - Sian Lloyd Jones
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Michelle Myall
- National Institute for Health and Care Research Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Lodge ME, Dhesi J, Shipway DJ, Braude P, Meilak C, Partridge J, Andrew NE, Srikanth V, Ayton DR, Moran C. The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study. BMC Health Serv Res 2024; 24:345. [PMID: 38491431 PMCID: PMC10943911 DOI: 10.1186/s12913-024-10844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK. METHODS A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR). RESULTS Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services. CONCLUSIONS Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
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Affiliation(s)
- Margot E Lodge
- National Centre for Healthy Ageing, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Jugdeep Dhesi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - David Jh Shipway
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Philip Braude
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK
| | - Catherine Meilak
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Judith Partridge
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Frankston, Australia
| | - Darshini R Ayton
- National Centre for Healthy Ageing, Melbourne, Australia.
- Health and Social Care Unit, Monash University, Melbourne, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Chris Moran
- National Centre for Healthy Ageing, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
- Peninsula Health, Frankston, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Al-Hammouri T, Almeida-Magana R, Soukup T, Lamb B. Implementation of streamlining measures in selecting and prioritising complex cases for the cancer multidisciplinary team meeting: a mini review of the recent developments. FRONTIERS IN HEALTH SERVICES 2024; 4:1340320. [PMID: 38533189 PMCID: PMC10964768 DOI: 10.3389/frhs.2024.1340320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.
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Affiliation(s)
- Tarek Al-Hammouri
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Urology, The Specialty Hospital, Amman, Jordan
| | - Ricardo Almeida-Magana
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tayana Soukup
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benjamin Lamb
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Department of Urology, Barts Health NHS Trust, London, United Kingdom
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Rushlow DR, Thacher TD, Barry BA. Building Capacity for Pragmatic Trials of Digital Technology in Primary Care. Mayo Clin Proc 2024; 99:491-501. [PMID: 38432751 DOI: 10.1016/j.mayocp.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 03/05/2024]
Abstract
Frontline primary care teams face important challenges in seeking to transform the quality of care delivered to patients and to reduce clerical burden for clinicians. Digital technologies using artificial intelligence hold substantial promise to aid in this transformation. Both pragmatic clinical trials and implementation science are key tools to successfully introduce, evaluate, and sustain innovations in real-world primary care practices. Previous articles in this thematic series have provided an in-depth overview of pragmatic trials and implementation science. This paper demonstrates and provides a framework for how these concepts, together with digital transformation, can be used to solve many of the challenges facing primary care. This framework is conceived as the collaboration of frontline primary care teams with innovators in academic institutions and industry through pragmatic trials and implementation science.
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Affiliation(s)
| | | | - Barbara A Barry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Smith MY, Gaglio B, Anatchkova M. The use of implementation science theories, models, and frameworks in implementation research for medicinal products: A scoping review. Health Res Policy Syst 2024; 22:17. [PMID: 38287407 PMCID: PMC10823700 DOI: 10.1186/s12961-024-01102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The uptake, adoption and integration of new medicines and treatment regimens within healthcare delivery can take a decade or more. Increasingly, implementation science (IS) research is being used to bridge this gap between the availability of new therapeutic evidence and its actual application in clinical practice. Little is known, however, about the quality of IS research in this area, including the degree to which theories, models and frameworks (TMFs) are being used. The objective of this study was to conduct a scoping review of the use of TMFs in implementation research involving medicinal products. METHODS A search was conducted for English language abstracts and manuscripts describing the application of TMFs in IS studies for medicinal products. Eligible publications were those published between 1 January 1974 and 12 December 2022. All records were screened at the title and abstract stage; included full-text papers were abstracted using data extraction tables designed for the study. Study quality was appraised using the Implementation Research Development Tool. RESULTS The initial scoping search identified 2697 publications, of which 9 were ultimately eligible for inclusion in the review. Most studies were published after 2020 and varied in their objectives, design and therapeutic area. Most studies had sample sizes of fewer than 50 participants, and all focused on the post-marketing phase of drug development. The TMF most frequently used was the Consolidated Framework for Implementation Research (CFIR). Although most studies applied all TMF domains, TMF use was limited to instrument development and/or qualitative analysis. Quality appraisals indicated the need for engaging patients and other stakeholders in the implementation research, reporting on the cost of implementation strategies, and evaluating the unintended consequences of implementation efforts. CONCLUSIONS We found that few IS studies involving medicinal products reported using TMFs. Those that did encompassed a wide variety of therapeutic indications and medicinal products; all were in the post-marketing phase and involved limited application of the TMFs. Researchers should consider conducting IS in earlier phases of drug development and integrating the TMFs throughout the research process. More consistent and in-depth use of TMFs may help advance research in this area.
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Affiliation(s)
- Meredith Y Smith
- Evidera, Inc., Bethesda, MD, United States of America.
- Department of Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America.
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Ali S, Yan Q, Sun H, Irfan M. Techno-economic analysis of biogas production from domestic organic wastes and locally sourced material: the moderating role of social media based-awareness. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:6460-6480. [PMID: 38148456 DOI: 10.1007/s11356-023-31543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Abstract
Management of organic waste addresses the issue of cleanliness and sanitation in developing nations such as Pakistan, where improper waste management usually leads to significant health problems and early mortality. The control of organic waste in rural regions of Pakistan and other developing nations needs to be undertaken using effective solutions. This study contributes to satisfying local needs such as cooking, lighting, and maintaining a comfortable temperature in anaerobic locations and works as a guideline for converting to biogas. This research aims to ascertain households' most substantial challenges concerning biogas production using domestic organic waste and locally sourced materials. The analysis is conducted on data from 81 respondents gathered using a comprehensive questionnaire assessment. Respondents were carefully chosen with the purposive sampling process. Primary data were collected from a structured questionnaire and partial least squares structural equation modeling (PLS-SEM) to evaluate the formulated assumptions. The results indicate that managing organic waste positively influences the sustainable improvement of biogas using human organic waste and locally resourced materials. The selected variables and their moderating effect significantly and favorably influence this conceptual model. Furthermore, all manipulating influences are constructively connected with implementing biogas technology using organic waste and locally resourced material, minimizing household energy expenses, and satisfying local needs. This study concludes that the government's green energy policy and economic incentives encourage households to use biogas energy produced from organic waste and locally resourced material. The government should use modern technology, resident training, and expert methodological assistance to induce households into biogas production using domestic organic waste and locally resourced material. Finally, the study's limitations and suggestions for further research are also addressed.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Huaping Sun
- School of Economics and Management, University of Science and Technology, Beijing, Beijing, 100083, China
| | - Muhammad Irfan
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.
- Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon.
- Department of Business Administration, ILMA University, Karachi, 75190, Pakistan.
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Ali S, Yan Q, Irfan M, Ai F, Sun H, Xiaochun Z. Does biogas energy influence the sustainable development of entrepreneurial business? An application of the extended theory of planned behavior. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:116279-116298. [PMID: 37910361 DOI: 10.1007/s11356-023-30352-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
As a result of air pollution and accelerated climate change, entrepreneurship is gradually becoming a deciding factor in the global conversation about saving the planet with renewable energy sources. To sustain the economy and entrepreneurial culture for future generations, researchers and entrepreneurs seek environmentally friendly methods for supporting entrepreneurial enterprises. Fossil fuel-based energy has significantly impeded the country's sustainable development. Pakistan lacks research examining the connection between biogas energy technology and entrepreneurship. This study aims to cover this void in the literature by employing the theory of planned behavior to investigate bioenergy as a business prospect for supportable monetary growth. The primary data comprises 358 comprehensive questionnaire survey respondents. PLS-SEM verifies the model and examines the suppositions. According to pragmatic findings, all views are positively and substantially associated with the sustainable progress of business enterprises implementing biogas energy. In contrast, social media awareness had no moderating effect on the dependent variable. Consequently, social media awareness substantially modifies the associations between all independent variables adopting biogas energy. The results of this research indicate the standing of altering social customs regarding private enterprise, increasing businesspersons' consciousness of these matters, reforming controlling arrangements, and highlighting the assistance of business events made possible by biogas energy technology, which increases businesspeople's investment returns. Conclusively, the study's limits and approvals for future research are emphasized.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Muhammad Irfan
- Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon
- Department of Business Administration, ILMA University, Karachi, 75190, Pakistan
| | - Fengyi Ai
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.
| | - Huaping Sun
- School of Economics and Management, University of Science and Technology Beijing, Beijing, 100083, China
- School of Finance and Economics, Jiangsu University, Zhenjiang, 212013, China
| | - Zhang Xiaochun
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
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Quasdorf T, Manietta C, Rommerskirch-Manietta M, Braunwarth JI, Roßmann C, Roes M. Implementation of interventions to maintain and promote the functional mobility of nursing home residents - a scoping review. BMC Geriatr 2023; 23:600. [PMID: 37752436 PMCID: PMC10523713 DOI: 10.1186/s12877-023-04213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/02/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To provide an overview of the available evidence on the implementation of direct and capacity-building interventions to promote and maintain the functional mobility of nursing home residents. METHODS We conducted a scoping review following the methodological guidance for the conduct of scoping reviews as described by the Joanna Briggs Institute. We searched for studies in MEDLINE (via PubMed) and CINAHL (via EBSCO). We conducted a qualitative content analysis of the included studies with deductive categories based on the Consolidated Framework for Implementation Research (CFIR). RESULTS Ultimately, we included 8 studies on direct interventions, 6 studies on capacity-building interventions, and 2 studies on both types of interventions in our review. Seven studies provided evidence on implementation strategies comprising discrete as well as multifaceted, multilevel strategies. Most of the studies did not systematically evaluate the strategies but remained at a descriptive level. All 16 studies provided evidence of influencing factors. We identified 32 of the 37 influencing factors of the CFIR. The five most frequent influencing factors were available resources (n = 14), access to knowledge and information (n = 12), patient needs and resources (n = 10), knowledge and beliefs about the intervention (n = 10) and compatibility (n = 9). CONCLUSIONS The available evidence on the implementation of functional mobility interventions in nursing homes is rather limited. This emphasizes the need for further research. Regarding implementation strategies, the systematic evaluation and further development of the reported promising approaches might be a starting point.
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Affiliation(s)
- Tina Quasdorf
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Christin Roßmann
- Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Ali S, Yan Q, Hu J, Irfan M, Sun H. Can bioenergy act as an entrepreneurial opportunity for the sustainable economic development of an emerging economy? A socio-technical approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:98106-98126. [PMID: 37606777 DOI: 10.1007/s11356-023-29211-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
Challenges in adopting renewable energy have become significant roadblocks to the country's sustainable progress. There is a shortage of studies examining how adopting biogas energy plants affects entrepreneurship in Pakistan's off-grid areas. This study aims to address this gap in the literature by investigating bioenergy as an entrepreneurial opportunity for the sustainable economic development of an emerging economy. Primary data comprising 305 respondents was used in Punjab Province by employing an inclusive questionnaire survey. The partial least square structural equation modeling (PLS-SEM) technique validates the model and analyzes the designated hypotheses. Empirical outcomes reveal that enhanced social and entrepreneurial prosperity adopting biogas plants, sustainable economic development of entrepreneurial businesses adopting biogas plants, and adoption in entrepreneurship improve the standard of living positively and significantly associated with intention to enhance entrepreneurship performance through biogas energy adoption. On the contrary, the production-cost reduction of adopting biogas plants in entrepreneurial businesses had no significant effect on intention to improve entrepreneurship performance through biogas energy adoption. Meanwhile, the intention to enhance entrepreneurship performance through biogas energy adoption positively mediates the relationship among enhanced social and entrepreneurial prosperity adopting biogas plants, sustainable economic development of entrepreneurial businesses adopting biogas plants, biogas plant adoption in entrepreneurship improves the standard of living, and economic development of entrepreneurial activities adopting biogas technology. Correspondingly, social media and word of mouth significantly moderate the relationships between the intention to enhance entrepreneurship performance through biogas energy adoption and the economic development of entrepreneurial activities adopting biogas energy. The results of this study show how crucial it is to change societal norms surrounding entrepreneurship, raise entrepreneurs' awareness of these issues, reform regulatory systems, and emphasize the benefits of entrepreneurial activities offered by biogas energy plants that grow entrepreneurs' standard of living. Finally, the study's limitations and recommendations for additional studies are highlighted.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Jin Hu
- School of Big Data Application and Economics, Guizhou University of Finance and Economics, Guiyang, 550025, Guizhou, China
| | - Muhammad Irfan
- School of Economics, Beijing Technology and Business University, Beijing, 100048, China.
- School of Business Administration, ILMA University, Karachi, 75190, Pakistan.
- Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon.
| | - Huaping Sun
- School of Economics and Management, University of Science and Technology Beijing, Beijing, 100083, China
- School of Finance and Economics, Jiangsu University, 212013, Zhenjiang, People's Republic of China
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11
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Hogg HDJ, Al-Zubaidy M, Keane PA, Hughes G, Beyer FR, Maniatopoulos G. Evaluating the translation of implementation science to clinical artificial intelligence: a bibliometric study of qualitative research. FRONTIERS IN HEALTH SERVICES 2023; 3:1161822. [PMID: 37492632 PMCID: PMC10364639 DOI: 10.3389/frhs.2023.1161822] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Introduction Whilst a theoretical basis for implementation research is seen as advantageous, there is little clarity over if and how the application of theories, models or frameworks (TMF) impact implementation outcomes. Clinical artificial intelligence (AI) continues to receive multi-stakeholder interest and investment, yet a significant implementation gap remains. This bibliometric study aims to measure and characterize TMF application in qualitative clinical AI research to identify opportunities to improve research practice and its impact on clinical AI implementation. Methods Qualitative research of stakeholder perspectives on clinical AI published between January 2014 and October 2022 was systematically identified. Eligible studies were characterized by their publication type, clinical and geographical context, type of clinical AI studied, data collection method, participants and application of any TMF. Each TMF applied by eligible studies, its justification and mode of application was characterized. Results Of 202 eligible studies, 70 (34.7%) applied a TMF. There was an 8-fold increase in the number of publications between 2014 and 2022 but no significant increase in the proportion applying TMFs. Of the 50 TMFs applied, 40 (80%) were only applied once, with the Technology Acceptance Model applied most frequently (n = 9). Seven TMFs were novel contributions embedded within an eligible study. A minority of studies justified TMF application (n = 51,58.6%) and it was uncommon to discuss an alternative TMF or the limitations of the one selected (n = 11,12.6%). The most common way in which a TMF was applied in eligible studies was data analysis (n = 44,50.6%). Implementation guidelines or tools were explicitly referenced by 2 reports (1.0%). Conclusion TMFs have not been commonly applied in qualitative research of clinical AI. When TMFs have been applied there has been (i) little consensus on TMF selection (ii) limited description of selection rationale and (iii) lack of clarity over how TMFs inform research. We consider this to represent an opportunity to improve implementation science's translation to clinical AI research and clinical AI into practice by promoting the rigor and frequency of TMF application. We recommend that the finite resources of the implementation science community are diverted toward increasing accessibility and engagement with theory informed practices. The considered application of theories, models and frameworks (TMF) are thought to contribute to the impact of implementation science on the translation of innovations into real-world care. The frequency and nature of TMF use are yet to be described within digital health innovations, including the prominent field of clinical AI. A well-known implementation gap, coined as the "AI chasm" continues to limit the impact of clinical AI on real-world care. From this bibliometric study of the frequency and quality of TMF use within qualitative clinical AI research, we found that TMFs are usually not applied, their selection is highly varied between studies and there is not often a convincing rationale for their selection. Promoting the rigor and frequency of TMF use appears to present an opportunity to improve the translation of clinical AI into practice.
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Affiliation(s)
- H. D. J. Hogg
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- The Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - M. Al-Zubaidy
- The Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - P. A. Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - G. Hughes
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom
- University ofLeicester School of Business, University of Leicester, Leicester, United Kingdom
| | - F. R. Beyer
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - G. Maniatopoulos
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- University ofLeicester School of Business, University of Leicester, Leicester, United Kingdom
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Ali S, Yan Q, Sun H, Irfan M. Sustainable green revolution through the development of solar power projects in Pakistan: a techno-economic analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:80123-80143. [PMID: 37291352 DOI: 10.1007/s11356-023-28117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
Energy is essential to a recent way of life that needs to be addressed in economic and environmentally supportable improvement negotiations. The economic output of solar energy development has become the primary concern, particularly in emerging nations like Pakistan. The present research estimates a techno-economic analysis and sustainable green revolution by improving this country's solar energy projects (SEP). The study observes the moderating role of top management and risk factors of the procedures between financial management procedures and the economic output of SEP. A comprehensive opinion poll assessment accomplishes the investigation on facts from 61 respondents (finance executives, financial managers, shareholders, and owner investors). Partly least squares structural equation modeling (PLS-SEM) evaluates the hypotheses. The findings indicate that a techno-economic analysis and green revolution favor the ecological improvement of solar energy installations. The cash-flow analysis significantly contributes to the SEP's improved economic output. In addition, the results reveal that the role of top management and risk factors suggestively moderate the relationship between financial management procedures and the economic output of SEP. These outcomes give policymakers, competent authorities, and regulators an excellent guide to upsurge cleaner fabrication and ecological improvement of SEP.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Huaping Sun
- School of Finance and Economics, Jiangsu University, 212013, Zhenjiang, People's Republic of China
- School of Economics and Management, University of Science and Technology Beijing, 100083, Beijing, China
| | - Muhammad Irfan
- School of Economics, Beijing Technology and Business University, Beijing, 100048, China.
- Department of Business Administration, ILMA University, Karachi, 75190, Pakistan.
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13
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Ali S, Yan Q, Dilanchiev A, Irfan M, Balabeyova N. Economic development, social media awareness, and technological innovation in biogas sector under climate change in the post-COVID-19 pandemic conditions. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:79960-79979. [PMID: 37289390 PMCID: PMC10248343 DOI: 10.1007/s11356-023-27965-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
After COVID-19, financing for emerging nation reserves in renewable energy bases was deemed a crucial aspect of sustainable development. Investing in biogas energy plants can be highly beneficial for lowering the use of fossil fuels. Using a survey of shareholders, investors, biogas energy professionals, and active social media participants in Pakistan, this study evaluates the intentions of individual investors to invest in biogas energy plants. The primary purpose of this study is to increase investment intent for biogas energy projects following COVID-19. This study focuses on financing biogas energy plants in the post-COVID-19 era and evaluates the research's assumptions using partial least squares structural equation modeling (PLS-SEM). The study employed the technique of purposive sampling to acquire data for this investigation. The results indicate that attitudes, perceived biogas energy benefits, perceived investment attitudes, and supervisory structure evaluations inspire one's propensity to finance biogas vitality plant efforts. The study found a link between eco-friendly responsiveness, monetary benefits, and investors' actions. The aspiration of investors to mark such reserves was set up to be unpretentious by their risk aversion. Conferring to the facts, evaluating the monitoring structure is the critical factor. The previous studies on investment behavior and other forms of pro-environmental intent and action yielded contradictory results. In addition, the regulatory environment was evaluated to see how the theory of planned behavior (TPB) affects financiers' objectives to participate in biogas power plants. The consequences of the study indicate that feelings of pride and discernment of energy expansively affect people's desire to invest in biogas plants. Biogas energy efficacy has little effect on investors' decisions to invest in biogas energy plants. This study offers policymakers practical ideas on enhancing investments in biogas energy plants.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Azer Dilanchiev
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Muhammad Irfan
- School of Economics and Management, Beijing Technology and Business University, Beijing, 100048, China.
- Department of Business Administration, ILMA University, Karachi, 75190, Pakistan.
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Yadav UN, Smith M, Agostino J, Sinka V, Williamson L, Wyber R, Butler DC, Belfrage M, Freeman K, Passey M, Walke E, Hammond B, Lovett R, Douglas KA. Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol. BMJ Open 2023; 13:e071234. [PMID: 37344121 DOI: 10.1136/bmjopen-2022-071234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule. This realist review aims to identify context-specific enablers and tensions and contribute to developing an evidence framework to guide the implementation of health checks in the prevention and early detection of chronic diseases for Aboriginal and Torres Strait Islander people. METHODS AND ANALYSIS The review will involve the following steps: (1) Aboriginal and Torres Strait Islander engagement and research governance; (2) defining the scope of the review; (3) search strategy; (4) screening, study selection and appraisal; (5) data extraction and organisation of evidence; (6) data synthesis and drawing conclusions. This realist review will follow the Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidance and will be reported as set up by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. The realist programme theory will be developed through a literature review using multiple database searches from 1 November 1999 to 31 June 2022, limited to the English language, and stakeholder consultation, which will be refined throughout the review process. The study findings will be reported by applying the context-mechanism-outcome configuration to gain a deeper understanding of context and underlying mechanisms that influence the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia. ETHICS AND DISSEMINATION Ethical approval is not required as this review will be using secondary data. Findings will be published in a peer-reviewed journal and presented at scientific conferences. SYSTEMATIC REVIEW REGISTRATION The review protocol has been registered on the international prospective register of systematic reviews: CRD42022326697.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Smith
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jason Agostino
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Victoria Sinka
- Centre for Kidney Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonie Williamson
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary Wyber
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Danielle C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Institute for Urban Indigenous Health, Windsor, Queensland, Australia
| | - Mary Belfrage
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Kate Freeman
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Emma Walke
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Belinda Hammond
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Raymond Lovett
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Luft H, Brown R, Lauver D. A hybrid type 2 effectiveness-implementation design to evaluate a community-based, heart-healthy intervention for women of low socio-economic status. Appl Nurs Res 2023; 71:151686. [PMID: 37179069 DOI: 10.1016/j.apnr.2023.151686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/28/2022] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Women of low socioeconomic status continue to experience a disproportionate burden of cardiovascular disease. To respond to their unique needs, we adapted the intervention and implementation strategy of an effective theory-based psychoeducational intervention for improving heart-healthy behaviors. Study aims were to evaluate implementation (i.e., reach, fidelity, acceptability, appropriateness) and effectiveness (i.e., perceived stress, common physical symptoms in primary care, physical activity, diet) of the adapted program we called mySTEPS. METHOD We used a hybrid type 2 effectiveness-implementation approach. To evaluate implementation, we conducted a process evaluation using data from research records, observation rubrics, and pre-/post-intervention surveys. To evaluate potential effectiveness, we used a one-group, pre-/post-test design with three, sequential offerings (16 weeks each) in unique settings, used standardized, quantitative measures at 8 weeks post-intervention, and calculated effect sizes. RESULTS Forty-two women were included in the evaluation. For reach, 66 % and 61 % of participants attended adequate numbers of educational and coaching sessions. Supporting fidelity of delivery, nurse implementers addressed 85-98 % of required criteria. Supporting fidelity of receipt, participants' pre- to post- knowledge scores increased and other scores revealed that nurse-implementers had interacted supportively throughout mySTEPS. Participants rated the acceptability and appropriateness of components positively. Effect-sizes revealed moderate decreases in stress, moderate increases in physical activity, and modest decreases in the number of physical symptoms. Dietary scores did not change. CONCLUSIONS The effectiveness and implementation of mySTEPS were positive overall. After strengthening the dietary component, more extensive evaluation of mySTEPS can be conducted to explain mechanisms of action. MESH HEADINGS Health behavior, prevention, self-determination theory, self-regulation theory, cardiovascular diseases, implementation strategies.
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Affiliation(s)
- Heidi Luft
- School of Nursing, University of Texas Medical Branch, United States.
| | - Roger Brown
- School of Nursing, School of Medicine & Public Health, Wisconsin-Madison, United States
| | - Diane Lauver
- School of Nursing, University of Wisconsin-Madison, United States
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Ali S, Yan Q, Irfan M, Fahad S. Relating biogas technology and environmental impact assessment: a roadmap towards clean energy for environmental sustainability. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27553-6. [PMID: 37178300 DOI: 10.1007/s11356-023-27553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Atmosphere contamination and fast weather change have compelled scientists and entrepreneurs to seek eco-friendly solutions for saving the earth. Increasing energy consumption depletes limited natural resources and harms the climate and ecology. In this regard, biogas technology contributes in two ways: satisfying energy needs and saving plants. Pakistan is a farming nation with enormous biogas-based energy generating potential. The primary objectives of this study are to identify the most significant barriers to farmers' investment in biogas technology. Non-probability sampling (purposive sampling) was utilized to establish the sample size. Ninety-seven investors and farmers were systematically sampled in biogas technology engaged in this survey. The planned questionnaire was practiced to obtain key facts via online interviews. The partial least square structural equation modeling (PLS-SEM) was used to evaluate designated hypotheses. The current research concludes that entire autonomous variables are substantial and interrelated with investment in biogas machinery, dropping energy disasters, and accomplishing environmental, financial, and maintenance government support objectives. The results also revealed that electronic and social media play a moderating influence. This conceptual model is considerably and positively affected by the chosen factors and their moderation. This study concludes that the primary tools for attracting farmers and investors in biogas technology are proper biogas technology awareness with relevant experts, financial and maintenance government responsibility, user efficiency and environmental concern of biogas plants, and the role of electronic and social media. The results also advised that the government should implement an incentive and maintenance policy to entice new farmers and investors in Pakistan to build biogas technology. Finally, the study's limitations and recommendations for additional studies are highlighted.
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Affiliation(s)
- Shahid Ali
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
| | - Qingyou Yan
- School of Economics and Management, North China Electric Power University, Beijing, 102206, China
- Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Beijing, 102206, China
| | - Muhammad Irfan
- School of Economics, Beijing Technology and Business University, Beijing, 100048, China.
- Faculty of Management Sciences, Department of Business Administration, ILMA University, Karachi, 75190, Pakistan.
| | - Shah Fahad
- School of Economics and Management, Leshan Normal University, Leshan, 614000, China
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Kirvalidze M, Abbadi A, Dahlberg L, Sacco LB, Morin L, Calderón-Larrañaga A. Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses. BMJ Open 2023; 13:e068646. [PMID: 37085312 PMCID: PMC10124259 DOI: 10.1136/bmjopen-2022-068646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves. DESIGN An umbrella review of systematic reviews was conducted. DATA SOURCES Quantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included. ELIGIBILITY CRITERIA Reviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers. DATA EXTRACTION AND SYNTHESIS A total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method. RESULTS The evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified. CONCLUSIONS Lack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector. PROSPERO REGISTRATION NUMBER CRD42021252841; BMJ Open: doi:10.1136/bmjopen-2021-053117.
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Affiliation(s)
- Mariam Kirvalidze
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Ahmad Abbadi
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Lena Dahlberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lawrence B Sacco
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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Roberts NA, Young AM, Duff J. Using Implementation Science in Nursing Research. Semin Oncol Nurs 2023; 39:151399. [PMID: 36894448 DOI: 10.1016/j.soncn.2023.151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Clinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice. DATA SOURCES A narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap. CONCLUSION Implementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation. IMPLICATIONS FOR NURSING PRACTICE By using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource.
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Affiliation(s)
- Natasha A Roberts
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia.
| | - Adrienne M Young
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jed Duff
- University of Queensland, Metro North Health, Herston, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia
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Davis SD, Bayes S, Geraghty S. Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study. Eur J Midwifery 2023; 7:1. [PMID: 36761447 PMCID: PMC9885374 DOI: 10.18332/ejm/157459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/18/2022] [Accepted: 12/14/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Transferring research evidence into midwifery practice is fraught with challenges and obstacles. Implementation tools can streamline the process and are most effective when they are discipline-specific; however, there are currently no midwifery specific implementation tools. The aim of this study was to develop a midwifery specific tool to identify barriers and enablers to evidence-informed practice change within the clinical setting. METHODS Participatory action research methodology was employed to ensure potential end-users contributed to content and format of the tool. Purposeful sampling ensured participants were selected from a range of midwifery practice settings in Western Australia and the United Kingdom. Data were collected through stakeholder advisory groups (SAGs) and online surveys. RESULTS Ten midwives participated in this project. Consultation occurred through face-to-face SAG meetings and online surveys until consensus was reached among participants about the content, format, and functionality of the end product which we called the 'Midwifery Tool for Change' (MT4C). CONCLUSIONS To our knowledge, the MT4C is the first readiness for change context assessment tool specific to midwifery practice settings. Evaluation of the MT4C in real-world practice change implementation initiatives will enable further refinement of the tool.
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Affiliation(s)
- Sara D. Davis
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Sara Bayes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Sadie Geraghty
- School of Nursing, Midwifery, Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
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Lee LE, Kulnik ST, Curran GM, Boaz A, Ramdharry GM. Protocol for a hybrid II study exploring the feasibility of delivering, evaluating, and implementing a self-management programme for people with neuromuscular diseases at a specialist neuromuscular centre. Pilot Feasibility Stud 2023; 9:4. [PMID: 36624548 PMCID: PMC9827010 DOI: 10.1186/s40814-022-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Self-management support (SMS) forms a central pillar in the management of long-term conditions. It is firmly aligned with UK health policy but there is a paucity of evidence exploring how it is enacted in the context of neuromuscular diseases (NMDs). Bridges is a SMS programme originally developed in stroke. A new version of the programme (Neuromuscular Bridges) has recently been co-designed with people with lived experience of NMD and requires evaluation. The implementation of SMS is inherently complex with potential barriers at the level of the patient, provider, and wider organisation. The success of implementing programmes can be highly dependent on context, indicating a rationale for considering implementation determinants at an early stage. This study aims to explore the feasibility of (1) delivering, (2) evaluating, and (3) implementing Neuromuscular Bridges at a specialist neuromuscular centre. METHODS This study employs a hybrid II design underpinned by Normalisation Process Theory (NPT), which has been used prospectively to inform the implementation plan and will also inform the analysis. The feasibility of delivering, evaluating, and implementing Neuromuscular Bridges will be assessed using a single-arm pre-post design. In terms of delivery and evaluation, we will explore acceptability, demand within the service, performance of outcome measures, recruitment, and retention. Implementation strategies have been selected from a refined taxonomy of strategies, mapped to NPT, and targeted at known barriers and facilitators at the specialist centre that were identified from preliminary stakeholder engagement activities. The impact of the strategy bundle on fidelity, acceptability, appropriateness, and adoption will be evaluated using qualitative interviews, administrative data, surveys, and a notes audit. CONCLUSIONS This this study will provide valuable feasibility data on a co-designed SMS programme for people with NMDs that will be used to inform a larger implementation study, requirements for embedding it in a specialist centre, and rollout to other specialist centres. Using hybrid methodology at the feasibility stage is unusual and this study will provide important insights into the usefulness of taking this approach at this point in the research pipeline. TRIAL REGISTRATION ISRCTN Trial ID: ISRCTN14208138 . Date registered: 18/08/2021.
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Affiliation(s)
- Laurence Edward Lee
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Stefan Tino Kulnik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Annette Boaz
- Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Gita M. Ramdharry
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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Fernandez Turienzo C, Hull LH, Coxon K, Bollard M, Cross P, Seed PT, Shennan AH, Sandall J. A continuity of care programme for women at risk of preterm birth in the UK: Process evaluation of a hybrid randomised controlled pilot trial. PLoS One 2023; 18:e0279695. [PMID: 36634125 PMCID: PMC9836307 DOI: 10.1371/journal.pone.0279695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The development and evaluation of specific maternity care packages designed to address preterm birth remains a public health priority. We aim to evaluate the implementation, context, and potential mechanisms of action, of a new care pathway that combined midwifery continuity of care with a specialist obstetric clinic for women at risk of preterm birth (POPPIE) in London (UK). METHODS We did a multiphase mixed method triangulation evaluation nested within a hybrid type 2, randomised controlled trial in London (United Kingdom). Pregnant women with identified risk factors for preterm birth were eligible for trial participation and randomly assigned (1:1) to either midwifery continuity of care linked to a specialist obstetric clinic (POPPIE group) or standard maternity care. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth, analysed according to intention to treat. Clinical and process outcome data were abstracted from medical records and electronic data systems, and coded by study team members, who were masked to study group allocation. Implementation data were collected from meeting records and key documents, postnatal surveys (n = 164), semi-structured interviews with women (n = 30), healthcare providers and stakeholders (n = 24) pre-, mid and post implementation. Qualitative and quantitative data from meeting records and key documents were examined narratively. Qualitative data from interviews were analysed using three thematic frameworks: Proctor's (for implementation outcomes: appropriateness, adoption, feasibility, acceptability, fidelity, penetration, sustainability), the Consolidated Framework for Implementation Research (for determinants of implementation), and published program theories of continuity models (for potential mechanisms). Data triangulation followed a convergent parallel and pragmatic approach which brought quantitative and qualitative data together at the interpretation stage. We averaged individual implementation measures across all domains to give a single composite implementation strength score which was compared to the primary outcome. RESULTS Between May 9, 2017, and Sep 30, 2018, 553 women were assessed for eligibility and 334 were enrolled with less than 6% of loss to follow up (169 were assigned to the POPPIE group; 165 were to the standard group). There was no difference in the primary outcome (POPPIE group 83·3% versus standard group 84·7%; risk ratio 0·98 [95% CI 0·90 to 1·08]). Appropriateness and adoption: The introduction of the POPPIE model was perceived as a positive fundamental change for local maternity services. Partnership working and additional funding were crucial for adoption. Fidelity: More than 75% of antenatal and postnatal visits were provided by a named or partner midwife, and a POPPIE midwife was present in more than 80% of births. Acceptability: Nearly 98% of women who responded to the postnatal survey were very satisfied with POPPIE model. Quantitative fidelity and acceptability results were supported by the qualitative findings. Penetration and sustainability: Despite delays (likely associated with lack of existing continuity models at the hospital), the model was embedded within established services and a joint decision was made to sustain and adapt the model after the trial (strongly facilitated by national maternal policy on continuity pathways). Potential mechanisms of impact identified included e.g. access to care, advocacy and perceptions of safety and trust. There was no association between implementation measures and the primary outcome. CONCLUSIONS The POPPIE model of care was a feasible and acceptable model of care that was implemented with high fidelity and sustained in maternity services. Larger powered trials are feasible and needed in other settings, to evaluate the impact and implementation of continuity programmes in other communities affected by preterm birth and women who experience social disadvantage and vulnerability. TRIAL REGISTRATION UKCRN Portfolio Database (prospectively registered, 24 April 2017): 31951. ISRCTN registry (retrospectively registered, 21 August 2017): ISRCTN37733900.
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Affiliation(s)
- Cristina Fernandez Turienzo
- Faculty of Life Sciences & Medicine, Department of Women and Children’s Health, King’s College London, London, United Kingdom
- * E-mail:
| | - Louise H. Hull
- Department of Health Services and Population Research, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Kirstie Coxon
- Department of Midwifery, Kingston University and St. George’s, University of London, United Kingdom
| | - Mary Bollard
- Maternity Services, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Pauline Cross
- Department of Public Health, London Borough of Lewisham, London, United Kingdom
| | - Paul T. Seed
- Faculty of Life Sciences & Medicine, Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Andrew H. Shennan
- Faculty of Life Sciences & Medicine, Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Jane Sandall
- Faculty of Life Sciences & Medicine, Department of Women and Children’s Health, King’s College London, London, United Kingdom
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22
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Jurczuk M, Thakar R, Carroll FE, Phillips L, van der Meulen J, Gurol-Urganci I, Sevdalis N. Design and management considerations for control groups in hybrid effectiveness-implementation trials: Narrative review & case studies. FRONTIERS IN HEALTH SERVICES 2023; 3:1059015. [PMID: 36926502 PMCID: PMC10012616 DOI: 10.3389/frhs.2023.1059015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
Hybrid effectiveness-implementation studies allow researchers to combine study of a clinical intervention's effectiveness with study of its implementation with the aim of accelerating the translation of evidence into practice. However, there currently exists limited guidance on how to design and manage such hybrid studies. This is particularly true for studies that include a comparison/control arm that, by design, receives less implementation support than the intervention arm. Lack of such guidance can present a challenge for researchers both in setting up but also in effectively managing participating sites in such trials. This paper uses a narrative review of the literature (Phase 1 of the research) and comparative case study of three studies (Phase 2 of the research) to identify common themes related to study design and management. Based on these, we comment and reflect on: (1) the balance that needs to be struck between fidelity to the study design and tailoring to emerging requests from participating sites as part of the research process, and (2) the modifications to the implementation strategies being evaluated. Hybrid trial teams should carefully consider the impact of design selection, trial management decisions, and any modifications to implementation processes and/or support on the delivery of a controlled evaluation. The rationale for these choices should be systematically reported to fill the gap in the literature.
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Affiliation(s)
- Magdalena Jurczuk
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Ranee Thakar
- Obstetrics & Gynaecology, Croydon University Hospitals NHS Trust, London, United Kingdom
| | - Fran E Carroll
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Lizzie Phillips
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Maternity Services, University Hospital Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
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Regalado ICR, Lindquist AR, Cardoso R, Longo E, Lencucha R, Hunt M, Thomas A, Bussières A, Boruff JT, Shikako K. Knowledge translation in rehabilitation settings in low, lower-middle and upper-middle-income countries: a scoping review. Disabil Rehabil 2023; 45:376-390. [PMID: 35188861 DOI: 10.1080/09638288.2022.2030415] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This review aims to identify the barriers and facilitators to knowledge use and Knowledge Translation (KT) strategies in rehabilitation in low, lower-middle, and upper-middle-income countries (LMICs). MATERIALS AND METHODS A scoping review of studies of KT in rehabilitation in LMICs contexts using the Arksey and O'Malley Framework was conducted. A comprehensive search of MEDLINE and 10 other databases was undertaken to identify studies conducted primarily in LMICs. RESULTS From the initial 15.606 titles identified; 27 articles were included for final analysis. Our analysis identified the following themes: Professional culture and context; KT interventions; and the conceptualization and application of KT and Evidence Based Practice (EBP). Individual-level barriers to KT included lack of skills, knowledge about EBP and English language, lack of motivation, and decision-making power. Facilitators to KT included positive attitudes and motivation. Organization-level barriers included lack of time, lack of financial resources, limited access to scientific journals, and applicability of research to rural settings. Facilitators included adequate financial and physical resources, a supportive management environment, and the existence of training and continuing education programs. CONCLUSION This review identified common and unique barriers and facilitators to KT in LMICs when compared to KT studies conducted in high-income settings.IMPLICATIONS FOR REHABILITATIONKnowledge Translation from academic institutions to rehabilitation clinical practice in low and upper-middle-income countries is important to support evidence-based practice and patient outcomes.Barriers at the individual level include professionals' ability to understand English and knowledge of the evidence-based practice.Organization-level barriers included lack of time to access and implement new practices, lack of financial and personal resources, limited access to scientific journals, and applicability of research to rural settings.Training and continuing education programs are needed to support rehabilitation professionals' efforts to achieve the application of evidence-based practice in clinical practice.
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Affiliation(s)
- I C R Regalado
- Department of Physiotherapy, Federal University of Rio Grande do Norte-UFRN, Avenida Senador Salgado Filho, Natal, Brazil
| | - A R Lindquist
- Department of Physiotherapy, Federal University of Rio Grande do Norte-UFRN, Avenida Senador Salgado Filho, Natal, Brazil
| | - R Cardoso
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - E Longo
- Department of Health of Children, Federal University of Rio Grande do Norte-UFRN/FACISA, Santa Cruz, Brazil
| | - R Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - M Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - J T Boruff
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - K Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Sweetnam C, Goulding L, Davis RE, Khadjesari Z, Boaz A, Healey A, Sevdalis N, Bakolis I, Hull L. Development and psychometric evaluation of the Implementation Science Research Project Appraisal Criteria (ImpResPAC) tool: a study protocol. BMJ Open 2022; 12:e061209. [PMID: 36526311 PMCID: PMC9764655 DOI: 10.1136/bmjopen-2022-061209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The need for quantitative criteria to appraise the quality of implementation research has recently been highlighted to improve methodological rigour. The Implementation Science Research development (ImpRes) tool and supplementary guide provide methodological guidance and recommendations on how to design high-quality implementation research. This protocol reports on the development of the Implementation Science Research Project Appraisal Criteria (ImpResPAC) tool, a quantitative appraisal tool, developed based on the structure and content of the ImpRes tool and supplementary guide, to evaluate the conceptual and methodological quality of implementation research. METHODS AND ANALYSIS This study employs a three-stage sequential mixed-methods design. During stage 1, the research team will map core domains of the ImpRes tool, guidance and recommendations contained in the supplementary guide and within the literature, to ImpResPAC. In stage 2, an international multidisciplinary expert group, recruited through purposive sampling, will inform the refinement of ImpResPAC, including content, scoring system and user instructions. In stage 3, an extensive psychometric evaluation of ImpResPAC, that was created in stage 1 and refined in stage 2, will be conducted. The scaling assumptions (inter-item and item-total correlations), reliability (internal consistency, inter-rater) and validity (construct and convergent validity) will be investigated by applying ImpResPAC to 50 protocols published in Implementation Science. We envisage developing ImpResPAC in this way will provide implementation research stakeholders, primarily grant reviewers and educators, a comprehensive, transparent and fair appraisal of the conceptual and methodological quality of implementation research, increasing the likelihood of funding research that will generate knowledge and contribute to the advancement of the field. ETHICS AND DISSEMINATION This study will involve human participants. This study has been registered and minimal risk ethical clearance granted by The Research Ethics Office, King's College London (reference number MRA-20/21-20807). Participants will receive written information on the study via email and will provide e-consent if they wish to participate. We will use traditional academic modalities of dissemination (eg, conferences and publications).
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Affiliation(s)
- Chloe Sweetnam
- Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lucy Goulding
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - Rachel E Davis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - Zarnie Khadjesari
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andy Healey
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
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Rapport F, Smith J, Hutchinson K, Clay-Williams R, Churruca K, Bierbaum M, Braithwaite J. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice. J Eval Clin Pract 2022; 28:991-1002. [PMID: 34268832 DOI: 10.1111/jep.13600] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. AIM In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co-designed research. DISCUSSION More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence-based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. CONCLUSION To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co-joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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26
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Loza E, Carmona L, Woolf A, Fautrel B, Courvoisier DS, Verstappen S, Aarrestad Provan S, Boonen A, Vliet Vlieland T, Marchiori F, Jasinski T, Van der Elst K, Ndosi M, Dziedzic K, Carrasco JM. Implementation of recommendations in rheumatic and musculoskeletal diseases: considerations for development and uptake. Ann Rheum Dis 2022; 81:1344-1347. [PMID: 35961760 DOI: 10.1136/ard-2022-223016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
A clinical guideline is a document with the aim of guiding decisions based on evidence regarding diagnosis, management and treatment in specific areas of healthcare. Specific to rheumatic and musculoskeletal diseases (RMDs), adherence to clinical guidelines recommendations impacts the outcomes of people with these diseases. However, currently, the implementation of recommendations is less than optimal in rheumatology.The WHO has described the implementation of evidence-based recommendations as one of the greatest challenges facing the global health community and has identified the importance of scaling up these recommendations. But closing the evidence-to-practice gap is often complex, time-consuming and difficult. In this context, the implementation science offers a framework to overcome this scenario.This article describes the principles of implementation science to facilitate and optimise the implementation of clinical recommendations in RMDs. Embedding implementation science methods and techniques into recommendation development and daily practice can help maximise the likelihood that implementation is successful in improving the quality of healthcare and healthcare services.
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Affiliation(s)
- Estibaliz Loza
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Bruno Fautrel
- Rheumatology, Pitie Salpetriere Hospital - Assistance Publique-Hopitaux de Paris, Paris, France.,INSERM UMRS 1136, Sorbonne University, Paris, France
| | | | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center+, Maastricht, Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Thea Vliet Vlieland
- Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Newcastle, UK
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Abstract
PURPOSE Implementation science aims to facilitate the use of evidence-based programs, practices, and policies in routine care settings. In audiology, as in other health disciplines, there is a persistent research-to-practice gap. Improving the adoption, reach, implementation, and sustainment of effective interventions in audiology would increase their public health impact, ensuring that all individuals needing hearing health care services could benefit from innovations and evidence-based best practices. This tutorial provides an introductory overview of implementation science relevant to the field of audiology, including Internet-based practices and interventions. METHOD Major concepts and themes of implementation science are presented, including implementation outcomes, implementation science frameworks, implementation strategies, current topics in implementation science, and study design considerations. Recent publications in audiology are highlighted to illustrate implementation science concepts and themes. The relevance of each topic to the use of evidence-based programs, practices, and policies in audiology is highlighted with reference to recent research in the field. CONCLUSIONS Challenges in the widespread delivery of evidence-based audiological practices and interventions limit their public health impact. The application of implementation science principles and methods in audiology research, as demonstrated in other areas of health research, can increase our focus on ensuring that effective practices are widely available, accessible, equitable, and sustainable to improve the lives of those who need them.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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28
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Lindström M, Lindholm L, Liv P. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities. Trials 2022; 23:657. [PMID: 35971130 PMCID: PMC9377097 DOI: 10.1186/s13063-022-06622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness. Methods The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff. Discussion This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness. Trial registration ClinicalTrials.gov NCT05056415. Registered on 24 September 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06622-0.
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per Liv
- Department of Public Health and Clinical Medicine, Umeå university, 901 87, Umeå, Sweden
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O'Connor M, Kennedy EE, Hirschman KB, Mikkelsen ME, Deb P, Ryvicker M, Hodgson NA, Barrón Y, Stawnychy MA, Garren PA, Bowles KH. Improving transitions and outcomes of sepsis survivors (I-TRANSFER): a type 1 hybrid protocol. BMC Palliat Care 2022; 21:98. [PMID: 35655168 PMCID: PMC9160516 DOI: 10.1186/s12904-022-00973-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This protocol is based on home health care (HHC) best practice evidence showing the value of coupling timely post-acute care visits by registered nurses and early outpatient provider follow-up for sepsis survivors. We found that 30-day rehospitalization rates were 7 percentage points lower (a 41% relative reduction) when sepsis survivors received a HHC nursing visit within 2 days of hospital discharge, at least 1 more nursing visit the first week, and an outpatient provider follow-up visit within 7 days compared to those without timely follow-up. However, nationwide, only 28% of sepsis survivors who transitioned to HHC received this timely visit protocol. The opportunity exists for many more sepsis survivors to benefit from timely home care and outpatient services. This protocol aims to achieve this goal. METHODS: Guided by the Consolidated Framework for Implementation Research, this Type 1 hybrid pragmatic study will test the effectiveness of the Improving Transitions and Outcomes of Sepsis Survivors (I-TRANSFER) intervention compared to usual care on 30-day rehospitalization and emergency department use among sepsis survivors receiving HHC. The study design includes a baseline period with no intervention, a six-month start-up period followed by a one-year intervention period in partnership with five dyads of acute and HHC sites. In addition to the usual care/control periods from the dyad sites, additional survivors from national data will serve as control observations for comparison, weighted to produce covariate balance. The hypotheses will be tested using generalized mixed models with covariates guided by the Andersen Behavioral Model of Health Services. We will produce insights and generalizable knowledge regarding the context, processes, strategies, and determinants of I-TRANSFER implementation. DISCUSSION As the largest HHC study of its kind and the first to transform this novel evidence through implementation science, this study has the potential to produce new knowledge about the impact of timely attention in HHC to alleviate symptoms and support sepsis survivor's recovery at home. If effective, the impact of this intervention could be widespread, improving the quality of life and health outcomes for a growing, vulnerable population of sepsis survivors. A national advisory group will assist with widespread results dissemination.
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Affiliation(s)
- Melissa O'Connor
- M. Louise College of Nursing, Villanova University, 800 Lancaster Avenue, Villanova, PA, 19085, USA
- Fellow, Betty Irene Moore Fellowship for Nurse Leaders and Innovators, Sacramento, CA, USA
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Erin E Kennedy
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Karen B Hirschman
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Mark E Mikkelsen
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Partha Deb
- Department of Economics, Hunter College, 695 Park Avenue, New York, 10065, USA
| | - Miriam Ryvicker
- Center for Home Care Policy & Research, VNS Health, 220 East 42nd Street, New York, NY, 10017, USA
| | - Nancy A Hodgson
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, 220 East 42nd Street, New York, NY, 10017, USA
| | - Michael A Stawnychy
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Patrik A Garren
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Kathryn H Bowles
- School of Nursing, NewCourtland Center for Transitions in Health, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA.
- Center for Home Care Policy & Research, VNS Health, 220 East 42nd Street, New York, NY, 10017, USA.
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Bunzli S. CORR Insights®: What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study. Clin Orthop Relat Res 2022; 480:688-689. [PMID: 35060935 PMCID: PMC8923567 DOI: 10.1097/corr.0000000000002120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Samantha Bunzli
- Research Associate, Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
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Piat M, Sofouli E, Wainwright M, Albert H, Rivest MP, Casey R, LeBlanc S, Labonté L, O'Rourke JJ, Kasdorf S. Translating mental health recovery guidelines into recovery-oriented innovations: A strategy combining implementation teams and a facilitated planning process. EVALUATION AND PROGRAM PLANNING 2022; 91:102054. [PMID: 35219017 DOI: 10.1016/j.evalprogplan.2022.102054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Recovery is the focus of mental health strategies internationally. However, little translation of recovery knowledge has occurred in mental health services. The purpose of this research is to bridge the gap between recovery guidelines and practice by developing a new implementation strategy involving the formation of implementation teams made up of different stakeholders (service users, service providers, managers, knowledge users) and facilitating a 12-meeting implementation planning process. Sevenmental health organizations across Canada successfully completed the process of translating the guidelines into a recovery-oriented innovation that was implemented. Fifty-five implementation team members were interviewed upon completion of the 12-meeting process. Findings indicate that implementation team members perceived the structured planning process as positive. Nevertheless, the language of implementation science remains difficult to understand for a non-academic audience. Key elements of the 12-meeting process included the value of consensus building among implementation team members and the subsequent shifting power relationships. While working with diverse stakeholders came with certain challenges, the process in itself was a form of system transformation. This type of engaged planning process was a significant departure from the more top-down approaches to organizational change that staff were used to.
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University, Quebec, Canada; Douglas Mental Health University Institute, Quebec, Canada.
| | - Eleni Sofouli
- Department of Psychiatry, McGill University, Quebec, Canada; Douglas Mental Health University Institute, Quebec, Canada.
| | - Megan Wainwright
- Department of Psychiatry, McGill University, Quebec, Canada; Douglas Mental Health University Institute, Quebec, Canada.
| | - Hélene Albert
- Université de Moncton, École de travail social, Moncton, New Brunswick, Canada.
| | - Marie-Pier Rivest
- Université de Moncton, École de travail social, Moncton, New Brunswick, Canada.
| | - Regina Casey
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada.
| | - Sébastien LeBlanc
- Université de Moncton, École de travail social, Moncton, New Brunswick, Canada.
| | - Lise Labonté
- Douglas Mental Health University Institute, Quebec, Canada.
| | - Joseph J O'Rourke
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada.
| | - Sarah Kasdorf
- Douglas Mental Health University Institute, Quebec, Canada.
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Francetic I, Meacock R, Elliott J, Kristensen SR, Britteon P, Lugo-Palacios DG, Wilson P, Sutton M. Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS). Implement Sci Commun 2022; 3:30. [PMID: 35287757 PMCID: PMC8919154 DOI: 10.1186/s43058-022-00280-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing awareness among researchers and policymakers of the potential for healthcare interventions to have consequences beyond those initially intended. These unintended consequences or "spillover effects" result from the complex features of healthcare organisation and delivery and can either increase or decrease overall effectiveness. Their potential influence has important consequences for the design and evaluation of implementation strategies and for decision-making. However, consideration of spillovers remains partial and unsystematic. We develop a comprehensive framework for the identification and measurement of spillover effects resulting from changes to the way in which healthcare services are organised and delivered. METHODS We conducted a scoping review to map the existing literature on spillover effects in health and healthcare interventions and used the findings of this review to develop a comprehensive framework to identify and measure spillover effects. RESULTS The scoping review identified a wide range of different spillover effects, either experienced by agents not intentionally targeted by an intervention or representing unintended effects for targeted agents. Our scoping review revealed that spillover effects tend to be discussed in papers only when they are found to be statistically significant or might account for unexpected findings, rather than as a pre-specified feature of evaluation studies. This hinders the ability to assess all potential implications of a given policy or intervention. We propose a taxonomy of spillover effects, classified based on the outcome and the unit experiencing the effect: within-unit, between-unit, and diagonal spillover effects. We then present the INTENTS framework: Intended Non-intended TargEted Non-Targeted Spillovers. The INTENTS framework considers the units and outcomes which may be affected by an intervention and the mechanisms by which spillover effects are generated. CONCLUSIONS The INTENTS framework provides a structured guide for researchers and policymakers when considering the potential effects that implementation strategies may generate, and the steps to take when designing and evaluating such interventions. Application of the INTENTS framework will enable spillover effects to be addressed appropriately in future evaluations and decision-making, ensuring that the full range of costs and benefits of interventions are correctly identified.
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Affiliation(s)
- Igor Francetic
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Rachel Meacock
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jack Elliott
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Søren R Kristensen
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Phillip Britteon
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - David G Lugo-Palacios
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organization, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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Estevao C, Baldellou Lopez M, Davis RE, Jarret L, Soukup T, Bakolis I, Healey A, Harrington J, Woods A, Crane N, Jones F, Pariante C, Fancourt D, Sevdalis N. Evaluation of a community-based performance arts programme for people who have experienced stroke in the UK: protocol for the SHAPER-Stroke Odysseys study. BMJ Open 2022; 12:e057805. [PMID: 35277410 PMCID: PMC8919447 DOI: 10.1136/bmjopen-2021-057805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Stroke survivors, once in the community, face challenges with their long-term rehabilitation care and present higher levels of loneliness, depression and anxiety than the rest of the population. A community-based performance arts programme, Stroke Odysseys (SO), has been devised to tackle the challenges of living with stroke in the UK. In this study, we aim to evaluate the implementation, impact and experiences of SO for stroke survivors. METHODS AND ANALYSIS Scaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER)-SO aims to scale-up SO to 75 participants and 47 stakeholders, while simultaneously evaluating the effectiveness and implementation of the programme. The main research aim is to evaluate the implementation, effectiveness, impact and experiences of a community-based performance arts programme (SO for stroke survivors). This mixed-methods study will evaluate the experience and impact of SO on those participating using mixed methods (interviews, observations and surveys) before and after each stage and carry out non-participant observations during a percentage of the workshops, training and tour. Data will be analysed using quantitative and qualitative approaches. This is a study within the SHAPER programme. ETHICS AND DISSEMINATION Ethical approval has been granted by the King's College London PNM Research Ethics Panel, REC reference: LRS/DP-20/21-21549. Written informed consent will be sought for participants and stakeholders. The results of the study will be reported and disseminated at international conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04864470.
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Affiliation(s)
- Carolina Estevao
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rachel E Davis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Tayana Soukup
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Centre for Implementation Science, King's College London, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Andy Healey
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Health Service and Population Research Department, King's Health Economics, King's College London, London, UK
| | - Jean Harrington
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Anthony Woods
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Nikki Crane
- Culture Team, King's College London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Carmine Pariante
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychological Medicine, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Culture Team, King's College London, London, UK
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Soukup T, Davis RE, Baldellou Lopez M, Healey A, Estevao C, Fancourt D, Dazzan P, Pariante C, Dye H, Osborn T, Bind R, Sawyer K, Rebecchini L, Hazelgrove K, Burton A, Manoharan M, Perkins R, Podlewska A, Chaudhuri R, Derbyshire-Fox F, Hartley A, Woods A, Crane N, Bakolis I, Sevdalis N. Study protocol: randomised controlled hybrid type 2 trial evaluating the scale-up of two arts interventions for postnatal depression and Parkinson's disease. BMJ Open 2022; 12:e055691. [PMID: 35105591 PMCID: PMC8808453 DOI: 10.1136/bmjopen-2021-055691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Research on the benefits of 'arts' interventions to improve individuals' physical, social and psychological well-being is growing, but evidence on implementation and scale-up into health and social care systems is lacking. This protocol reports the SHAPER-Implement programme (Scale-up of Health-Arts Programmes Effectiveness-Implementation Research), aimed at studying the impact, implementation and scale-up of: Melodies for Mums (M4M), a singing intervention for postnatal depression; and Dance for Parkinson's (PD-Ballet) a dance intervention for Parkinson's disease. We examine how they could be embedded in clinical pathways to ensure their longer-term sustainability. METHODS AND ANALYSIS A randomised two-arm effectiveness-implementation hybrid type 2 trial design will be used across M4M/PD-Ballet. We will assess the implementation in both study arms (intervention vs control), and the cost-effectiveness of implementation. The design and measures, informed by literature and previous research by the study team, were refined through stakeholder engagement. Participants (400 in M4M; 160 in PD-Ballet) will be recruited to the intervention or control group (2:1 ratio). Further implementation data will be collected from stakeholders involved in referring to, delivering or supporting M4M/PD-Ballet (N=25-30 for each intervention).A mixed-methods approach (surveys and semi-structured interviews) will be employed. 'Acceptability' (measured by the 'Acceptability Intervention Measure') is the primary implementation endpoint for M4M/PD-Ballet. Relationships between clinical and implementation outcomes, implementation strategies (eg, training) and outcomes will be explored using generalised linear mixed models. Qualitative data will assess factors affecting the acceptability, feasibility and appropriateness of M4M/PD-Ballet, implementation strategies and longer-term sustainability. Costs associated with implementation and future scale-up will be estimated. ETHICS AND DISSEMINATION SHAPER-PND (the M4M trial) and SHAPER-PD (the PD trial) are approved by the West London and GTAC (20/PR/0813) and the HRA and Health and Care Research Wales (REC Reference: 20/WA/0261) Research Ethics Committees. Study findings will be disseminated through scientific peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBERS Both trials are registered with NIH US National Library of Medicine, ClinicalTrials.gov. The trial registration numbers, URLs of registry records, and dates of registration are: (1) PD-Ballet: URL: NCT04719468 (https://eur03.safelinks.protection. OUTLOOK com/?url=https%3A%2F%2Fwww.clinicaltrials.gov%2Fct2%2Fshow%2FNCT04719468%3Fterm%3DNCT04719468%26draw%3D2%26rank%3D1&data=04%7C01%7Crachel.davis%40kcl.ac.uk%7C11a7c5142782437919f808d903111449%7C8370cf1416f34c16b83c724071654356%7C0%7C0%7C6375441942616) (date of registration: 22 Jan 2021). (2) Melodies for Mums: NCT04834622 (https://clinicaltrials.gov/ct2/show/NCT04834622?term=shaper-pnd&draw=2&rank=1) (date of registration: 8 Apr 2021).
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Affiliation(s)
- Tayana Soukup
- Centre Implementation Science, King's College London, London, UK
| | - Rachel E Davis
- Centre Implementation Science, King's College London, London, UK
| | | | - Andy Healey
- Centre Implementation Science, King's College London, London, UK
| | - Carolina Estevao
- Department of Psychological Medicine, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, King's College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, King's College London, London, UK
| | - Hannah Dye
- Breathe Arts Health Research, London, UK
| | - Tim Osborn
- Breathe Arts Health Research, London, UK
| | - Rebecca Bind
- Department of Psychological Medicine, King's College London, London, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Katie Hazelgrove
- Department of Psychological Medicine, King's College London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Rosie Perkins
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Performance Science, Royal College of Music, London, UK
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | | | | | - Anthony Woods
- Department of Psychological Medicine, King's College London, London, UK
| | - Nikki Crane
- Department of Psychological Medicine, King's College London, London, UK
| | - Ioannis Bakolis
- Centre Implementation Science, King's College London, London, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Nick Sevdalis
- Centre Implementation Science, King's College London, London, UK
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D'Lima D, Soukup T, Hull L. Evaluating the Application of the RE-AIM Planning and Evaluation Framework: An Updated Systematic Review and Exploration of Pragmatic Application. Front Public Health 2022; 9:755738. [PMID: 35155336 PMCID: PMC8826088 DOI: 10.3389/fpubh.2021.755738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background RE-AIM is one of the most widely applied frameworks to plan and evaluate the implementation of public health and health behavior change interventions. The objective of this review is to provide an updated synthesis of use of the RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance) planning and evaluation framework and explore pragmatic use (i.e., partial application of the framework) and how this is reported. Methods Systematic review. MEDLINE (R) and PsycINFO were searched, via the Ovid interface, between January 2011 and December 2017. Studies that applied RE-AIM as a planning and/or evaluation framework were included. Results One hundred fifty-seven articles met inclusion criteria. One hundred forty-nine reported using RE-AIM for evaluation, three for planning and five for planning and evaluation. Reach was the most frequently reported dimension (92.9%), followed by implementation (90.3%), adoption (89.7%), effectiveness (84.5%), and maintenance (77.4%). One hundred forty-seven/one hundred fifty-seven articles originated from high-income economy countries. Within a sub-set analysis (10% of included articles), 9/15 articles evaluated all dimensions. Of the 6/15 articles that did not evaluate all dimensions, five provided no justification for pragmatic application. Conclusions RE-AIM has gained increased use in recent years and there is evidence that it is being applied pragmatically. However, the rationale for pragmatic use is often not reported. Systematic Review Registration PROSPERO (CRD42017054616).
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Affiliation(s)
- Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, United Kingdom
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
- *Correspondence: Louise Hull
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Edwards Iii GF, Zagarese V, Tulk Jesso S, Jesso M, Harden SM, Parker SH. Designing healthcare for human use: Human factors and practical considerations for the translational process. FRONTIERS IN HEALTH SERVICES 2022; 2:981450. [PMID: 36925891 PMCID: PMC10012824 DOI: 10.3389/frhs.2022.981450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
In recent years, the focus of implementation science (IS) shifted to emphasize the influence of contextual factors on intervention adaptations in clinical, community, and corporate settings. Each of these settings represent a unique work system with varying contexts that influence human capabilities, needs, and performance (otherwise known as "human factors"). The ease of human interaction with a work system or an intervention is imperative to IS outcomes, particularly adoption, implementation, and maintenance. Both scientific approaches consider the "big picture" when designing interventions for users and stakeholders to improve work and health outcomes. IS and human factors are therefore complementary in nature. In this paper, the authors will (1) provide perspective on the synergistic relationship between human factors and IS using two illustrative and applied cases and (2) outline practical considerations for human factors-based strategies to identify contextual factors that influence intervention adoption, implementation, and maintenance dimensions of the RE-AIM framework. This article expands on recent research that developed user- and human-centered design strategies for IS scientists to use. However, defining the complementary relationship between IS and human factors is a necessary and valuable step in maximizing the effectiveness of IS to transform healthcare. While IS can complement practitioners' identification of intervention adaptations, human interaction is a process in the work system often overlooked throughout implementation. Further work is needed to address the influence that organizational endorsement and trust have on intervention adaptations and their translation into the work system.
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Affiliation(s)
- G Franklin Edwards Iii
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, United States
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Stephanie Tulk Jesso
- Systems Science and Industrial Engineering, SUNY Binghamton University, Vestal, NY, United States
| | - Matthew Jesso
- Human Factors, Carilion Clinic, Roanoke, VA, United States
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Sarah Henrickson Parker
- Human Factors, Carilion Clinic, Roanoke, VA, United States.,Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
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Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, Verhey R, Shidhaye R, Thornicroft G, Araya R, Sevdalis N. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health 2021; 6:e005365. [PMID: 34969685 PMCID: PMC8718460 DOI: 10.1136/bmjgh-2021-005365] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022] Open
Abstract
Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Department of Health Service and Population Research, King's College London, London, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Rondebosch, South Africa
| | - Jamie Murdoch
- University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | | | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | | | | | - Nick Sevdalis
- Health Service & Population Research Department, King's College London, London, UK
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Wickham S, Fancourt D. Perspective Commentary: The Implementation of Welfare Policies Are Not Held to the Same Ethical Standards as Research: Raising Intergenerational Health Inequality Concerns. Front Public Health 2021; 9:764559. [PMID: 34888286 PMCID: PMC8650605 DOI: 10.3389/fpubh.2021.764559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Over the last 12 years the United Kingdom (UK) has seen the introduction of an austerity programme-a fiscal policy-with the primary goal to reduce the government's budget deficit and the role of the welfare system. Between 2010 and 2015 there was an estimated reduction of £14.5 billion in spending, attributable to decreasing the value of benefits and restricting entitlement to benefit claimants. By 2020, there had been an estimated unprecedented £27 billion less spent on welfare compared with spending in 2010. Whilst fiscally-successful at reducing spending, some implemented welfare policies have had direct consequences for people's health, increasing inequalities which have been heavily criticized. Moreover, there is growing concern that this has an intergenerational effect. In this paper, we describe the ethical principles in human research, how these have been considered in public health policy, and the existing evidence of the direct and intergenerational health and welfare consequences of some recent, nationally-implemented welfare policies. We argue that ethical principles, specifically the ethical principle of safety that is applied in all research, should be applied to all public welfare policies to stop the rising inequalities in health we are seeing across generations. We highlight that initial changes implemented to welfare policies as a response to COVID-19 demonstrate that there can be a political and societal perceived value in going further to support individuals and their families during times of adversity, and consider the ethical implications of this.
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Affiliation(s)
- Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
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Bootstrapping implementation research training: A successful approach for academic health centers. J Clin Transl Sci 2021; 5:e168. [PMID: 34733544 PMCID: PMC8532185 DOI: 10.1017/cts.2021.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022] Open
Abstract
Demand for building competencies in implementation research (IR) outstrips supply of training programs, calling for a paradigm shift. We used a bootstrap approach to leverage external resources and create IR capacity through a novel 2-day training for faculty scientists across the four Texas Clinical & Translational Science Awards (CTSAs). The Workshop combined internal and external expertise, targeted nationally established IR competencies, incorporated new National Institutes of Health/National Cancer Institute OpenAccess online resources, employed well-known adult education principles, and measured impact. CTSA leader buy-in was reflected in financial support. Evaluation showed increased self-reported IR competency; statewide initiatives expanded. The project demonstrated that, even with limited onsite expertise, it was possible to bootstrap resources and build IR capacity de novo in the CTSA community.
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technol Assess 2021; 25:1-132. [PMID: 34590577 PMCID: PMC7614019 DOI: 10.3310/hta25570] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. METHODS There were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert review was obtained. The process was overseen by a Scientific Advisory Group representing the range of relevant National Institute for Health Research and Medical Research Council research investments. RESULTS Key changes to the previous framework include (1) an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context; (2) an emphasis on the use of diverse research perspectives: efficacy, effectiveness, theory-based and systems perspectives; (3) a focus on the usefulness of evidence as the basis for determining research perspective and questions; (4) an increased focus on interventions developed outside research teams, for example changes in policy or health services delivery; and (5) the identification of six 'core elements' that should guide all phases of complex intervention research: consider context; develop, refine and test programme theory; engage stakeholders; identify key uncertainties; refine the intervention; and economic considerations. We divide the research process into four phases: development, feasibility, evaluation and implementation. For each phase we provide a concise summary of recent developments, key points to address and signposts to further reading. We also present case studies to illustrate the points being made throughout. LIMITATIONS The framework aims to help research teams prioritise research questions and design and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. In many of the areas of innovation that we highlight, such as the use of systems approaches, there are still only a few practical examples. We refer to more specific and detailed guidance where available and note where promising approaches require further development. CONCLUSIONS This new framework incorporates developments in complex intervention research published since the previous edition was written in 2006. As well as taking account of established practice and recent refinements, we draw attention to new approaches and place greater emphasis on economic considerations in complex intervention research. We have introduced a new emphasis on the importance of context and the value of understanding interventions as 'events in systems' that produce effects through interactions with features of the contexts in which they are implemented. The framework adopts a pluralist approach, encouraging researchers and research funders to adopt diverse research perspectives and to select research questions and methods pragmatically, with the aim of providing evidence that is useful to decision-makers. FUTURE WORK We call for further work to develop relevant methods and provide examples in practice. The use of this framework should be monitored and the move should be made to a more fluid resource in the future, for example a web-based format that can be frequently updated to incorporate new material and links to emerging resources. FUNDING This project was jointly funded by the Medical Research Council (MRC) and the National Institute for Health Research (Department of Health and Social Care 73514).
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Affiliation(s)
- Kathryn Skivington
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Huybrechts I, Declercq A, Verté E, Raeymaeckers P, Anthierens S. The Building Blocks of Implementation Frameworks and Models in Primary Care: A Narrative Review. Front Public Health 2021; 9:675171. [PMID: 34414155 PMCID: PMC8369196 DOI: 10.3389/fpubh.2021.675171] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Our aim is to identify the core building blocks of existing implementation frameworks and models, which can be used as a basis to further develop a framework for the implementation of complex interventions within primary care practices. Within the field of implementation science, various frameworks, and models exist to support the uptake of research findings and evidence-based practices. However, these frameworks and models often are not sufficiently actionable or targeted for use by intervention designers. The objective of this research is to map the similarities and differences of various frameworks and models, in order to find key constructs that form the foundation of an implementation framework or model that is to be developed. Methods: A narrative review was conducted, searching for papers that describe a framework or model for implementation by means of various search terms, and a snowball approach. The core phases, components, or other elements of each framework or model are extracted and listed. We analyze the similarities and differences between the frameworks and models and elaborate on their core building blocks. These core building blocks form the basis of an overarching model that we will develop based upon this review and put into practice. Results: A total of 28 implementation frameworks and models are included in our analysis. Throughout 15 process models, a total of 67 phases, steps or requirements are extracted and throughout 17 determinant frameworks a total of 90 components, constructs, or elements are extracted and listed into an Excel file. They are bundled and categorized using NVivo 12© and synthesized into three core phases and three core components of an implementation process as common elements of most implementation frameworks or models. The core phases are a development phase, a translation phase, and a sustainment phase. The core components are the intended change, the context, and implementation strategies. Discussion: We have identified the core building blocks of an implementation framework or model, which can be synthesized in three core phases and three core components. These will be the foundation for further research that aims to develop a new model that will guide and support intervention designers to develop and implement complex interventions, while taking account contextual factors.
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Affiliation(s)
- Ine Huybrechts
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Free University of Brussels, Brussels, Belgium
| | - Anja Declercq
- LUCAS - Centre for Care Research and Consultancy & CESO - Centre for Sociological Research, Catholic University of Leuven, Leuven, Belgium
| | - Emily Verté
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Free University of Brussels, Brussels, Belgium
| | - Peter Raeymaeckers
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Wilcox S, Jake-Schoffman DE, Saunders RP, Kinnard D, Kaczynski AT, Hutto B, James KL. Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative. Transl Behav Med 2021; 11:419-429. [PMID: 32221601 DOI: 10.1093/tbm/ibaa025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Deborah Kinnard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Katherine L James
- South Carolina Conference of the United Methodist Church, Columbia, SC
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Thomas A, Bussières A. Leveraging knowledge translation and implementation science in the pursuit of evidence informed health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1157-1171. [PMID: 33651210 DOI: 10.1007/s10459-020-10021-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Brakema EA, van der Kleij RM, Poot CC, Chavannes NH, Tsiligianni I, Walusimbi S, An PL, Sooronbaev T, Numans ME, Crone MR, Reis RR. A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries. BMJ Glob Health 2021; 6:bmjgh-2020-003221. [PMID: 33436446 PMCID: PMC7805378 DOI: 10.1136/bmjgh-2020-003221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/06/2020] [Accepted: 11/27/2020] [Indexed: 01/18/2023] Open
Abstract
Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.
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Affiliation(s)
- Evelyn A Brakema
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Charlotte C Poot
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraclion, Crete, Greece
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Matty R Crone
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria R Reis
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,The Children's Institute, University of Cape Town, Cape Town, South Africa
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Keir A, Grace E, Stanworth S. Closing the evidence to practice gap in neonatal transfusion medicine. Semin Fetal Neonatal Med 2021; 26:101197. [PMID: 33541808 DOI: 10.1016/j.siny.2021.101197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Significant resources are directed towards world-class research projects, but the findings are not necessarily translated into better healthcare outcomes, either at all or in a sustained way. There is a clear need to dedicate further resources to understanding how to promote the uptake of evidence and effectively change neonatal transfusion practice to improve outcomes. Approaching blood transfusion behaviour change more systematically, and working across disciplines and involving families, holds the potential to increase the rate of uptake of emerging evidence in clinical practice. This approach holds the potential to save costs, conserve resources, and improve clinical outcomes. Our paper focuses on the use of quality improvement to bridge the gap between evidence-based knowledge and transfusion practice in neonatal units around the world.
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Affiliation(s)
- Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, South Australia, Australia; Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, South Australia, Australia; Women's and Babies Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
| | - Erin Grace
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, South Australia, Australia; Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, South Australia, Australia; Women's and Babies Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Simon Stanworth
- National Health Service (NHS) Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Zhao J, Li X, Yan L, Yu Y, Hu J, Li SA, Chen W. The use of theories, frameworks, or models in knowledge translation studies in healthcare settings in China: a scoping review protocol. Syst Rev 2021; 10:13. [PMID: 33413662 PMCID: PMC7792291 DOI: 10.1186/s13643-020-01567-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) theories, frameworks, and models (TFMs) can help guide and explain KT processes, and facilitate the evaluation of implementation outcomes. They play a critical role in conducting KT research and practice. Currently, little is known about the usage of TFMs in KT in Chinese healthcare settings. The aim of this scoping review is to identify which TFMs had been used for KT in healthcare settings in China, and how these TFMs were used. METHODS The protocol for this scoping review is in accordance with the Arksey and O'Malley framework and further enhanced by the recommendations suggested by Levac et al. We will search 8 databases (4 Chinese and 4 English) to identify relevant studies. Four reviewers (2 for Chinese, 2 for English) will independently screen studies based on the eligibility criteria. The basic characteristic of studies and the TFMs utilization (i.e., what, why, and how) will be extracted. Methodological quality and reporting quality will be assessed using the Mixed Method Appraisal Tool (MMAT) and the Standards for Reporting Implementation Studies (StaRI) (or Standards for Quality Improvement Reporting Excellence, SQUIRE 2.0 for quality improvement studies), respectively. All the retrieved TFMs will be categorized into Nilsen's classifications of TFMs for KT research. We will employ the qualitative content analysis approach to summarize how these TFMs have been used, and the rationale. A consultation will be conducted through a 1-h interactive virtual meeting with an expert panel of knowledge users. DISCUSSION By conducting this scoping review, we expect to gain a comprehensive and in-depth understanding of why and how TFMs have been used in KT research and practice in China, and to identify gaps and provide recommendations for more efficient and meaningful use of TFMs in the future. SYSTEMATIC REVIEW REGISTRATION This review has been registered with the Open Science Framework (10.17605/OSF.IO/8NXAM).
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Affiliation(s)
- Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario Canada
| | - Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, China
| | - Lijiao Yan
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, China
| | - Yamei Yu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, Virginia USA
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario Canada
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario Canada
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Shenderovich Y, Ward CL, Lachman JM, Wessels I, Sacolo-Gwebu H, Okop K, Oliver D, Ngcobo LL, Tomlinson M, Fang Z, Janowski R, Hutchings J, Gardner F, Cluver L. Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: study protocol. Implement Sci Commun 2020; 1:109. [PMID: 38624613 PMCID: PMC7719848 DOI: 10.1186/s43058-020-00086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation.Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification. Discussion This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.
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Affiliation(s)
- Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Catherine L. Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Inge Wessels
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Kufre Okop
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Zuyi Fang
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Roselinde Janowski
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Davis R, D’Lima D. Building capacity in dissemination and implementation science: a systematic review of the academic literature on teaching and training initiatives. Implement Sci 2020; 15:97. [PMID: 33126909 PMCID: PMC7597006 DOI: 10.1186/s13012-020-01051-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The field of dissemination and implementation (D&I) science has grown significantly over recent years. Alongside this, an increased demand for training in D&I from researchers and implementers has been seen. Research describing and evaluating D&I training opportunities, referred to here as 'capacity building initiatives' (CBIs), can help provide an understanding of different methods of training as well as training successes and challenges. However, to gain a more detailed understanding of the evidence-base and how D&I CBIs are being reported in publications, a field-wide examination of the academic literature is required. METHODS Systematic review to identify the type and range of D&I CBIs discussed and/or appraised in the academic literature. EMBASE, Medline and PsycINFO were searched between January 2006 and November 2019. Articles were included if they reported on a D&I CBI that was developed by the authors (of each of the included articles) or the author's host institution. Two reviewers independently screened the articles and extracted data using a standardised form. RESULTS Thirty-one articles (from a total of 4181) were included. From these, 41 distinct D&I CBIs were identified which focussed on different contexts and professions, from 8 countries across the world. CBIs ranged from short courses to training institutes to being part of academic programmes. Nearly half were delivered face-face with the remainder delivered remotely or using a blended format. CBIs often stipulated specific eligibility criteria, strict application processes and/or were oversubscribed. Variabilities in the way in which the D&I CBIs were reported and/or evaluated were evident. CONCLUSIONS Increasing the number of training opportunities, as well as broadening their reach (to a wider range of learners), would help address the recognised deficit in D&I training. Standardisation in the reporting of D&I CBIs would enable the D&I community to better understand the findings across different contexts and scientific professions so that training gaps can be identified and overcome. More detailed examination of publications on D&I CBIs as well as the wider literature on capacity building would be of significant merit to the field.
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Affiliation(s)
- Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Danielle D’Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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The utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) and the facilitator role for introducing patient-reported outcome measures (PROMs) in a medical oncology outpatient department. Qual Life Res 2020; 30:3063-3071. [PMID: 33089474 PMCID: PMC8528793 DOI: 10.1007/s11136-020-02669-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE We evaluated the utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) for introducing patient-reported outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients. METHODS A pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation. RESULTS Important barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation. CONCLUSION The i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.
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Khadjesari Z, Boufkhed S, Vitoratou S, Schatte L, Ziemann A, Daskalopoulou C, Uglik-Marucha E, Sevdalis N, Hull L. Implementation outcome instruments for use in physical healthcare settings: a systematic review. Implement Sci 2020; 15:66. [PMID: 32811517 PMCID: PMC7433178 DOI: 10.1186/s13012-020-01027-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings. METHOD The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument. RESULTS Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability. CONCLUSION Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017 CRD42017065348.
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Affiliation(s)
- Zarnie Khadjesari
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
- Behavioural and Implementation Science research group, School of Health Sciences, University of East Anglia, Edith Cavell Building, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Sabah Boufkhed
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Laura Schatte
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Alexandra Ziemann
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Centre for Healthcare Innovation Research, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Christina Daskalopoulou
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Eleonora Uglik-Marucha
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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