The updated Consolidated Framework for Implementation Research based on user feedback

Digital health competences and AI beliefs as conditions for the practice of evidence-based medicine: a study of prospective physicians in Canada

BACKGROUND

The practice of evidence-based medicine (EBM) has become pivotal in enhancing medical care and patient outcomes. With the diffusion of innovation in healthcare organizations, EBM can be expected to depend on medical professionals' competences with digital health (dHealth) and artificial intelligence (AI) technologies.

OBJECTIVE

We aim to investigate the effect of dHealth competences and perceptions of AI on the adoption of EBM among prospective physicians. By focusing on dHealth and AI technologies, the study seeks to inform the redesign of medical curricula to better prepare students for the demands of evidence-based medical practice.

METHODS

A cross-sectional survey was administered online to students at the University of Montreal's medical school, which has approximately 1,400 enrolled students. The survey included questions on students' dHealth competences, perceptions of AI, and their practice of EBM. Using structural equation modeling (SEM), we analyzed data from 177 respondents to test our research model.

RESULTS

Our analysis indicates that medical students possess foundational knowledge competences of dHealth technologies and perceive AI to play an important role in the future of medicine. Yet, their experiential competences with dHealth technologies are limited. Our findings reveal that experiential dHealth competences are significantly related to the practice of EBM (β = 0.42, p < 0.001), as well as students' perceptions of the role of AI in the future of medicine (β = 0.39, p < 0.001), which, in turn, also affect EBM (β = 0.19, p < 0.05).

CONCLUSIONS

The study underscores the necessity of enhancing students' competences related to dHealth and considering their perceptions of the role of AI in the medical profession. In particular, the low levels of experiential dHealth competences highlight a promising starting point for training future physicians while simultaneously strengthening their practice of EBM. Accordingly, we suggest revising medical curricula to focus on providing students with practical experiences with dHealth and AI technologies.

The development and implementation of an innovative community-based intervention to strengthen community capacity for HIV prevention and care among Canadians of African Caribbean and Black (ACB) women in Ontario: a research protocol

African, Caribbean, and Black (ACB) women are overrepresented among new HIV diagnoses due to social and structural factors. This study seeks to create, implement, and evaluate a community-based peer-led intervention to improve access to HIV prevention and care for ACB women in Canada. This multisite, five-year project, using community-based participatory research, implementation science and evaluation frameworks, will be implemented in five non-iterative phases. Phase 1: Community and partner engagement; Phase 2: Critical health and racial literacy training curriculum and HIV resource development; Phase 3: Implementation research with first cohort of trained HIV Peer Equity Navigators [PENs] in three sites; Phase 4: Training of second cohort of HIV PENs and program implementation of HIV PEN intervention across Ontario; and Phase 5: Evaluation, knowledge sharing and plans for national scale up. We will use a mixed methods approach, including quantitative and qualitative data, such as surveys and qualitative interviews, to analyze and identify implementation scenarios, changes in improving access, and ensuring equity to HIV prevention and care for ACB women in Ontario, Canada. Evidence on the effectiveness of this innovative, peer-led intervention will be used to inform policies and practice related to HIV prevention and care for ACB women in Canada.

CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial

The CARD system (Comfort Ask Relax Distract) is a protocol for vaccine delivery that includes interventions that facilitate vaccine recipient coping and improve the vaccination experience. CARD was compared to control (usual care) in a pragmatic hybrid effectiveness-implementation cluster randomized trial. Of 25 participating community pharmacies, 12 were randomized to CARD and 13 to control for all vaccines administered between November 2023 and January 2024. Implementation strategies planned to support CARD integration included an educational webinar, customized implementation recommendations, change equipment, online chat group, and audit and feedback. Educational outreach was added to improve intervention fidelity. This paper reports on implementation outcomes of the trial. Provider surveys and focus groups revealed acceptability and feasibility of CARD and implementation strategies. Vaccinators in CARD pharmacies (vs. control) reported higher satisfaction with vaccine recipient interactions and that overall, CARD was time neutral. They also reported higher utilization of some CARD-recommended injection techniques. Administrative data verified utilization of the CARD coping checklist, which solicits vaccine recipient coping preferences, in 96% of vaccine recipients that participated. Post-vaccination feedback surveys were available for 90% of vaccine recipients that participated. Implementation results were aligned with trial effectiveness outcomes, and support routine use of CARD in community pharmacies.Trial registration : NCT06098703.

Advancement of the implementation of evidence-based therapies for cardiovascular-kidney-metabolic conditions: A multi-stakeholder perspective

Cardiovascular disease remains the leading cause of mortality and healthcare expenditures in the United States. It is also a major contributor to premature mortality, years lived with disability, and rising healthcare costs around the world. Despite the availability of proven therapies and interventions that could vastly decrease the burden of cardiovascular disease and cardiometabolic conditions, their implementation is poor, with generally less than half of patients being treated with the most effective therapies. Implementation science offers promise in bridging this gap and mitigating disparities. However, even though small studies have shown that there are effective methods to improve the implementation of evidence-based therapies, these methods have not been scaled to make an impact at the level of health systems or nationally. A coordinated, multi-stakeholder approach is essential to identify barriers to implementation on a broad scale and, more critically, to develop and deploy practical solutions. The Duke Clinical Research Institute conducted an Implementation Summit entitled "Scalability, Spread, and Sustainability" to explore strategies for advancing the uptake of evidence-based interventions for cardiometabolic diseases in healthcare in the United States. This manuscript presents the participants' multi-stakeholder perspective on the steps necessary to improve the implementation of evidence-based therapies in cardiometabolic disease. Key recommendations include focused efforts on evidence generation around broad implementation strategies, dissemination of the evidence generated, uptake of evidence into usual care settings, and investment in training the current and next generations of leaders in implementation.

The impact of electronic medical records on maternal healthcare: A scoping review

BACKGROUND

Electronic medical records (EMRs) offer benefits in healthcare but also present challenges in maternity care. While EMRs have transformed healthcare and enhanced patient care and clinical research, their related tasks may disrupt woman-centred care and increase documentation burdens. However, there is insufficient evidence of the impact of EMRs on maternal healthcare.

OBJECTIVE

This scoping review identified contemporary implementation issues and outcomes guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Quintuple Aim for Healthcare Improvement frameworks.

METHODS

This scoping review identified studies from seven databases (MEDLINE, CINAHL, Embase, Scopus, Web of Science, IEEE Xplore, and ACM) published between 2019 and 2024 using search terms related to EMRs and maternal healthcare.

RESULTS

Thirteen studies on EMRs in maternity settings were included. EMRs positively affected maternal healthcare, as seen through RE-AIM and Quintuple Aim. However, limited attention is given to provider satisfaction, cost-effectiveness, and health equity. On the RE-AIM, studies frequently focused on health service setting-level outcomes with little attention to patient-level and provider-level outcomes. Key enablers of successful EMR implementation included stakeholder involvement, user training, and the willingness of healthcare providers to adapt. Challenges such as data quality issues, high initial costs, patient refusal, staffing complexities, alarm fatigue, and low EMR usage among maternity patients impacted the overall reach and effectiveness of the EMRs.

CONCLUSION

Future research should prioritise evaluating the impacts of EMRs through a comprehensive lens aligned with Quintuple Aim outcomes to ensure informed decision-making and enhance maternal healthcare practices.

Implementation strategies for improving the care of familial hypercholesterolaemia from the International Atherosclerosis Society: next steps in implementation science and practice

Familial hypercholesterolaemia (FH) is the most common monogenic condition associated with premature atherosclerotic cardiovascular disease. Early detection and initiation of cholesterol lowering therapy combined with lifestyle changes improves the prognosis of patients with FH significantly. The International Atherosclerosis Society (IAS) published a new guidance for implementing best practice in the care of FH. Previous guidelines and position statements seldom provided implementation recommendations. To address this, an implementation science approach was used to generate implementation strategies for the clinical recommendations made. This process entailed the generation by consensus of strong implementation recommendations according to the Expert Recommendations for Implementing Change (ERIC) taxonomy. A total of 80 general and specific implementation recommendations were generated, addressing detection (screening, diagnosis, genetic testing and counselling) and management (risk stratification, treatment of adults or children with heterozygous or homozygous FH, therapy during pregnancy and use of apheresis) of patients with FH. We describe here the IAS guidance core implementation strategies to assist with the adoption of clinical recommendations into routine practice for at-risk patients and families worldwide. We summarise the IAS guidance core implementation strategies as operative statements.

Series on The Lancet Oncology Commission on Global Cancer Surgery Action 2: Education and Training

BACKGROUND

The ability to deliver safe, timely, affordable, and high-quality cancer surgery depends on an adequate cadre of well-trained and competent cancer surgeons. It is well-known that wide variations and inequities exist in the educational platforms for training cancer surgeons on the global stage. The second Lancet Oncology Commission on Global Cancer Surgery Action on education and training is geared toward creating robust, sustainable, and affordable educational platforms for training cancer surgeons globally.

METHODS AND RESULTS

This study used the principles of implementation science taken from the Consolidated Framework for Implementation Research to help develop the content and increase the likelihood of success in implementing the recommendations in this Action.

CONCLUSION

The Annals of Surgical Oncology series on the Second Lancet Oncology Commission on Global Cancer Surgery hopes to enhance the visibility of the eight critical actions within this important Commission to the primary stakeholders, the surgeons. Thie authors hope this Action on education and training will help to increase availability and modernize and develop contextually appropriate and resource-stratified educational platforms of appropriate length for training the next generation of competent cancer surgeons.

Review of the facilitators and barriers to adoption of biofortified foods and food products

Biofortification - the process of increasing the concentrations of essential nutrients in staple crops - is a means of addressing the burden of micronutrient deficiencies at a population level via existing food systems, such as smallholder farms. To realise its potential for global impact, we need to understand the factors that are associated with decisions to adopt biofortified crops and food products. We searched the literature to identify adoption determinants, i.e. barriers to (factors negatively associated) or facilitators of (factors positively associated) adoption, of biofortified crops and food products. We found 41 studies reporting facilitator(s) and/or barrier(s) of adoption. We categorised the factors using the Consolidated Framework of Implementation Research 2.0, resulting in a set of factors that enable or constrain adoption of biofortified foods across twenty-four constructs and five domains of this meta-theoretical determinant framework from implementation science. Facilitators of orange sweet potato adoption included knowledge about importance, relative advantage, efficient production and management practices; barriers included lacking timely access to quality vines and market remoteness (28 studies total). Facilitators of vitamin A cassava adoption included awareness of its benefits and access to information; barriers included poor road networks and scarcity of improved technology including inadequate processing/storage facilities (8). Facilitators of high-iron bean adoption included farmers' networking and high farming experience; barriers included low knowledge of bean biofortification (8). Barriers to vitamin A maize adoption included low awareness and concerns regarding yield, texture and aflatoxin contamination (1). These barriers and facilitators may be a starting point for researchers to move towards testing implementation strategies and/or for policymakers to consider before planning scale-up and continuous optimisation of ongoing projects promoting adoption of biofortified crops and food products.

Design and implementation of a risk-adapted, longitudinal, theory-driven medication adherence intervention: A protocol for a multi-phasic, hybrid effectiveness-implementation trial

BACKGROUND

The increasing use of targeted oral anticancer agents (OAAs) has transformed cancer treatment, yet patient adherence in real-world settings remains suboptimal. This protocol outlines a multi-phasic, hybrid effectiveness-implementation trial designed to develop, implement, and evaluate a risk-adapted, longitudinal medication adherence intervention for patients prescribed OAAs.

METHODS

Drawing on social cognitive theory, intervention mapping, and implementation science, the study aims to address barriers at cognitive, behavioral, and environmental levels that impact adherence. Phase 1 identifies implementation barriers and refines strategies, informed by expert input and semi-structured interviews. Phase 2 incorporates patient-centered feedback to tailor a theory-driven intervention targeting adherence barriers. In Phase 3, the intervention is piloted across diverse clinical settings to assess its effectiveness and implementation feasibility.

CONCLUSION

This trial aims to deliver a scalable and sustainable model for adherence support, with broad implications for improving patient outcomes and integrating adherence monitoring in routine cancer care.

Design and baseline characteristics of an implementation study to increase activity with social incentives: The STEP together trial

BACKGROUND

The majority of people in the United States do not achieve recommended levels of physical activity. Even small, daily increases can have health benefits. Wearable devices paired with social incentives increased daily steps in pilot studies but have not been tested for long-term effectiveness in community settings. This paper describes the study design and baseline participant characteristics of a trial testing these approaches to increase physical activity among families in the Philadelphia area.

METHODS

The trial, called STEP Together, is a Hybrid Type 1 effectiveness-implementation study. Participants enroll on family teams of 2-10 people, including at least one person 60 years old or older. Each participant receives a Fitbit device, establishes a baseline daily step count, and selects a daily step goal 1500 to 3000 steps greater than their baseline. Family teams are stratified based on family size and randomized to Control, Social Incentive Gamification, or Social Goals through Incentives to Charity. Participation is 18-months: a 12-month intervention and 6-month follow up.

RESULTS

779 participants on 285 family teams were randomized. Recruitment was more difficult than anticipated due to the COVID-19 pandemic and higher-than expected numbers of participants who were already physically active and therefore ineligible. Changes to the eligibility criteria that did not impact the underlying intent or conceptual basis for the trial improved recruitment feasibility.

CONCLUSION

The results from this study will contribute to the growing body of evidence about scalable, effective strategies to motivate individuals and families to increase their daily physical activity.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04942535.

Supervised Toothbrushing Programmes: Understanding Barriers and Facilitators to Implementation

OBJECTIVES

Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs.

METHODS

This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).

RESULTS

A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external 'make or break' conditions; (3) the importance of engagement across the system; and (4) desire for centralised support.

CONCLUSIONS

This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.

Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings

PURPOSE

To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings.

METHODS

Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0.

RESULTS

A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing.

CONCLUSIONS

Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation.

IMPLICATIONS FOR CANCER SURVIVORS

Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.

"It's something we're connected to": Acceptability and adoption of overdose detection technologies implemented in San Francisco permanent supportive housing

INTRODUCTION

The transition from homelessness to permanent supportive housing (PSH) is associated with solitary drug use, which heightens the risk for fatal overdose. Overdose detection technologies show promise in reducing fatal overdose in supportive housing environments. We conducted a longitudinal, mixed-methods study in a 50-unit single-room occupancy PSH building in San Francisco, California-tracing the implementation of wall-mounted, push-activated technologies (Brave Buttons) that alert designated responders to potential onsite emergencies, including overdose.

METHODS

Between May 2021 and February 2022, we conducted 35 days of naturalistic observation as well as serial, semi-structured interviews with 8 building staff (e.g., housing services coordinators, front desk clerks, custodians) and 5 tenant specialists, who promoted and sensitized residents to Brave Buttons prior to their installation. We administered surveys to all residents, assessing acceptability and uses of Brave Buttons. We calculated descriptive statistics regarding Brave Button installations and activations using administrative device data. Through inductive, iterative thematic analysis, we synthesized participant narratives to identify early expectations, implementation determinants, and adaptive strategies to bolster acceptability and adoption of Brave Buttons.

RESULTS

Despite high demand for overdose prevention solutions, staff and tenant specialists initially expressed doubts towards the adoption potential of Brave Buttons in the PSH building, citing resident mistrust of novel technologies with surveillance properties, liability related to (failed) overdose responses, and building staff capacity and willingness to respond to Button activations. Responding to these anticipated implementation constraints, a group of staff and tenant specialists hosted "engagement sessions" to build resident affinity/trust with Brave Buttons and leveraged tenant specialists' rapport with residents for technology sensitization. By December 2021, Buttons were voluntarily installed in 72 % of resident rooms and were used for multiple purposes, including overdoses and safety/wellness checks. The Buttons also helped formalize informal systems of care among residents and strengthened connections between residents and building staff.

CONCLUSION

Adaptive strategic planning, responsive to emerging sources of implementation opposition, was critical to addressing perceived barriers to Brave Button acceptability and adoption in the PSH building.

The Double-Edged Sword of Translational Research: Stakeholder Perspectives of the Enablers and Challenges Implementing Anorexia Nervosa Treatment in Rural Health Settings

OBJECTIVE

To explore the translational research processes that emerged at the early phase of the implementation of telehealth-delivered family-based therapy (FBT) for young people with anorexia nervosa (AN) attending Australian rural health services.

SETTING

Commencing mid-2019, five rural health districts across New South Wales (NSW) participated in the study.

PARTICIPANTS

Nine stakeholders, including study coordinators, clinicians and eating disorder coordinators, participated in a semi-structured interview during the early implementation of telehealth-delivered FBT.

DESIGN

Inductive thematic analysis methodology was used to identify key research factors that enabled and challenged the implementation.

RESULTS

The translational research improved patient access to evidence-based care, afforded health services access to clinical expertise, workforce training and supervision and assisted with meeting government directives of improving care pathways. However, the study and intervention implementation were challenged by research-related factors, including ethical and clinical dilemmas, the burden of stakeholders holding multiple roles and general challenges associated with integrating research into non-academic health services.

CONCLUSION

To optimise implementation and to bridge the access gaps particularly felt by rural families and health settings, translational studies ought to consider the enablers and challenges identified by the stakeholders.

TRIAL REGISTRATION

ACTRN12620001107910.

Use of Implementation Science Concepts in the Study of Misinformation: A Scoping Review

Misinformation hinders the impact of public health initiatives. Efforts to counter misinformation likely do not consider the full range of factors known to affect how individuals make decisions and act on them. Implementation science tools and concepts can facilitate the development of more effective interventions against health misinformation by leveraging advances in behavior specification, uptake of evidence, and theory-guided development and evaluation of complex interventions. We conducted a scoping review of misinformation literature reviews to document whether and how important concepts from implementation science have already informed the study of misinformation. Of 90 included reviews, the most frequently identified implementation science concepts were consideration of mechanisms driving misinformation (78%) and ways to intervene on, reduce, avoid, or circumvent it (71%). Other implementation science concepts were discussed much less frequently, such as tailoring strategies to the relevant context (9%) or public involvement in intervention development (9%). Less than half of reviews (47%) were guided by any theory, model, or framework. Among the 26 reviews that cited existing theories, most used theory narratively (62%) or only mentioned/cited the theory (19%), rather than using theory explicitly to interpret results (15%) or to inform data extraction (12%). Despite considerable research and many summaries of how to intervene against health misinformation, there has been relatively little consideration of many important advances in the science of health care implementation. This review identifies key areas from implementation science that might be useful to support future research into designing effective misinformation interventions.

Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities

BACKGROUND

The current pediatric mental health crisis has disproportionately impacted Latino youth in the United States (US), as demonstrated by their elevated risks of depression, substance use disorder, and anxiety. Despite this, research suggests Latino youth receive inequitable mental health services.

OBJECTIVE

To understand best practices, challenges, and priorities in providing accessible and equitable mental health care for Latino youth from the perspectives of front-line mental health providers and Latino community members.

METHODS

A bicultural, bilingual researcher conducted semi-structured interviews with 20 participants with expertise in Latino mental health. Topics included barriers and facilitators to mental health care access and cultural tailoring of treatment for Latino youth. Rapid qualitative analysis was used to identify themes.

RESULTS

Four themes were identified: (1) Navigating immigration concerns and acculturation, practitioners should consider immigration-related concerns and be trained to address acculturation-related stressors respectfully; (2) Adapting to the cultural needs and strengths of the communities, cultural humility education can allow providers to engage with both the strengths and needs of Latino families; (3) Engaging Latino caregivers as partners, it is critical to engage with Latino caregivers' cultural perspectives on parenting and mental health collaboratively; and (4) Addressing systemic barriers to promote access, providers must recognize and attempt to alleviate the systemic barriers that limit families from seeking care.

CONCLUSIONS

Participants identified several practical strategies to improve the provision of mental health services for Latino children. Future directions, policy and practice implications, and limitations are discussed.

An innovative Data sharing and Visualisation Tool (DAVIT) to improve domestic abuse data insight and multi-agency collaborations: An explorative study of acceptability, relevance and implementation considerations

Objectives

Domestic Abuse (DA) is a public health concern impacting multiple sectors. Partnerships and coordinated responses from statutory agencies are vital to ensure DA survivors' needs are met, but this is impeded by the accessibility of quality DA data. We present an innovative data sharing and visualisation tool (DAVIT) and its perceived potential to improve DA insight and multi-agency collaborations.

Study design

Qualitative exploratory study.

Methods

DAVIT was developed by Surrey County Council (SCC) through a consultation and prioritisation process with multi-agencies interested in DA. Focus group discussions (FGDs) were conducted on Zoom with representatives of agencies responding to DA in Surrey area to obtain their views regarding the relevance, acceptability and the potential for implementing DAVIT into practice. Qualitative data analysis was guided by the updated Consolidation Framework of Implementation Research (CFIR).

Results

Fifteen individuals representing seven agencies participated in 1-h long FGDs. Participants perceived DAVIT as well-designed, simple to use and adaptable to the local context but it needed improvements in data quality and comprehensiveness. Our findings suggest that DAVIT could enable intelligent planning and allocation of resources, delivery of targeted interventions and commissioning of DA service. Organisations' networks and connections, favourable data governance structure, policies, and regulations (outer settings); availability of resources, knowledge & information (inner settings); and individuals' capacity, competence and support from high-level leaders will all influence the implementation of DAVIT into practice.

Conclusions

DAVIT is acceptable and if improved and successfully implemented into practice could improve DA services. Provision of minimal training to data officers in organisations will maximize the utility of DAVIT. A clear data governance structure and data sharing framework will help the implementation of DAVIT.

Evidence adaptation and tailored implementation of family bereavement support in specialised palliative care: A multi-method study

Background

Families experiencing the loss of their close other following advanced illness have varying degrees of needs that stretch into bereavement. Evidence-based recommendations for bereavement support are often not well implemented in palliative care services due to multiple system barriers and lack of contextual fit. To close this know-do gap, we undertook an implementation science research project.

Objective

To adapt evidence-informed recommendations for supporting bereaved families to the local context, and to develop a tailored implementation strategy for their integration in specialised palliative care services.

Settings and participants

Two specialised palliative care services located at urban teaching hospitals in German-speaking Switzerland. Participants were palliative care staff working in the service, including nurses, physicians, chaplains, psychologists, and two service users.

Methods

Multi-method implementation research project combining community engagement strategies, qualitative contextual analysis, and theory-driven implementation design processes for integrating evidence-informed interventions in new contexts: First, evidence was identified and adapted through co-design staff workshops and service user consultations, following intervention adaptation guidelines. Next, focus group interviews were held to identify barriers and facilitators to implementation, informed by the Consolidated Framework for Implementation Research and analysed using qualitative content analysis. Drawing on implementation mapping methodology, a systematic and participatory process was used to develop an implementation plan that specified activities needed to address identified barriers and support integration into palliative care services.

Results

The study resulted in an adapted bereavement support pathway with three core functions of evidence-informed practices delivered during dying, at death, three-to-six, and if necessary nine-to-twelve months post-loss: screening and assessing family needs and risks, intervention and support activities for families, and team collaboration and coordination within and across providers. Implementation was expected to be influenced by the features of the intervention itself, staff competencies, and organisational conditions, with resources required being a frequent barrier, whereas workplace culture and the project-related network acted as facilitators. A multifaceted implementation strategy with 16 distinct activities was developed to reach 70 % of bereaved families: designing a practical, implementable pathway, creating necessary team capacity and roles, optimizing workflow, offering education and clinician support, ensuring leadership and organisational commitment, and facilitating mutual exchange and learning. An implementation research logic model specified expected mechanisms of impact and outcomes.

Conclusions

The project resulted in an adapted bereavement support intervention fitted to local palliative care contexts and a tailored implementation plan. Adapting evidence to specific contexts and understanding potential barriers and facilitators is necessary to prepare implementation.

Registration

https://osf.io/qgr7y.

The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: a meta-review of outcomes, neurobiology and key determinants

Research examining physical activity interventions for mental disorders has grown exponentially in the past decade. At this critical juncture, there is a need to synthesize the best evidence to guide researchers, clinicians and people with lived experience. This meta-review aimed to systematically identify and comprehensively evaluate the current evidence about: a) the efficacy of physical activity interventions on mental, cognitive and physical outcomes for individuals with mental disorders; b) the potential neurobiological, psychosocial and behavioral mechanisms underlying the observed effects; and c) the barriers and facilitators for individuals to successfully engage in these interventions. Our systematic search identified 13 meta-analyses of high methodological quality (i.e., A Measurement Tool to Assess Systematic Reviews, AMSTAR score ≥8) assessing outcomes of physical activity as an adjunctive treatment, which included 256 randomized clinical trials (RCTs) and 12,233 individuals. Large effect sizes were found for adjunctive physical activity interventions in improving attention in children and adolescents with attention-deficit/hyperactivity disorder (ADHD); reducing depressive symptoms in children, adolescents and adults with depressive disorders; and reducing body mass index in adults with schizophrenia. Moderate effect sizes were found for reductions of hyperactivity, impulsivity and anxiety, and improvements of executive and social functioning in children and adolescents with ADHD; reduction of anxiety symptoms in adults with anxiety disorders; improved physical and psychological quality of life and cardiovascular fitness in adults with depressive disorders; improved daily living skills, overall quality of life and cardiorespiratory fitness in adults with schizophrenia; reduction of depressive symptoms in older people with depressive disorders; and improvements in cognition and functional mobility in older people with dementia. There is, to date, no meta-analytic evidence for physical activity as a first-line treatment for people with a mental disorder. Five meta-analyses, including 89 RCTs and 4,575 individuals, investigated potential underlying mechanisms. There is a very preliminary evidence for an effect of physical activity on circulating levels of kynurenine, growth hormone, tumor necrosis factor-alpha and brain-derived neurotrophic factor in people with major depressive disorder. No meta-analytic evidence could be found for psychosocial or behavioral mechanisms. Based on 15 umbrella or systematic reviews, covering 432 studies and 48 guidelines, six implementation strategies, along with the most evidence-based behavioral change techniques to support them, were identified. Recommendations to support implementation research in this area were finally formulated.

Organizational evidence-based practice culture, implementation leadership, and nurses: A bidirectional mediation model

AIM

This study aimed to explore 1) factors that influenced the evidence-based practice competencies and behaviors of clinical nurses and 2) the interaction between the organizational evidence-based practice culture, head nurses' implementation leadership, and nurses' evidence-based practice competencies and behaviors.

BACKGROUND

The significance of organizational evidence-based practice culture and head nurses' implementation leadership in enhancing nurses' evidence-based practice competencies and behavior is widely recognized in healthcare settings. However, there is limited knowledge of how these factors influence nurses' evidence-based practice competencies and behavior.

METHODS

A cross-sectional survey was conducted at 10 hospitals in China. Data were collected via online questionnaires from October to December 2020, utilizing social characteristic questionnaires, the Evidence-Based Practice Questionnaire, the Organizational Culture and Readiness Scale for System-wide Implementation of Evidence-Based Practice, and the Implementation Leadership Scale. All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis. The design and reporting of our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist.

RESULTS

We received 1047 (99.15%) valid questionnaires. The multiple linear regression analysis showed that significant factors were organizational evidence-based practice culture, implementation leadership, and years of experience in nursing. After controlling for the impact of the covariate (years of experience in nursing), it was found that organizational evidence-based practice culture partially mediated the relationship between head nurses' implementation leadership and nurses' evidence-based practice competencies and behaviors. Additionally, head nurses' implementation leadership partially mediated the relationship between organizational evidence-based practice culture and nurses' evidence-based practice competencies and behaviors.

CONCLUSION

Organizational evidence-based practice culture, head nurses' implementation leadership, and years of experience in nursing significantly predict nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture and head nurses' implementation leadership mutually mediated their influence on nurses' implementation of evidence-based practice.

IMPLICATIONS FOR NURSING AND POLICY

Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership. Policymakers should also consider providing more policy support for implementing leadership development and cultivating a positive evidence-based practice culture.

[Factors in the implementation of expert standards in nursing: A qualitative study]

Factors in the implementation of expert standards in nursing: A qualitative study Abstract: Background: Many German health and long-term care facilities face the challenge of implementing expert standards in practice. Implementation models, such as the Consolidated Framework for Implementation Research (CFIR), support the implementation process by identifying the relevant influencing factors that can determine the success of an implementation. Aim: The aim was to identify the factors influencing the implementation of expert standards in nursing care and their interactions. Method: The data were collected by means of guided interviews with ten facilitators of the model implementation units for the implementation of the expert standard on promotion of oral health in nursing and from the project progress records. The data were evaluated by content analysis. Results: In addition to the influencing factors according to the CFIR, two other factors were identified that can determine the success of the implementation of expert standards - local presence and knowledge of implementation theories and models. The various and complex interrelationships between the factors in the implementation of expert standards became particularly clear. Conclusion: Knowledge of the fundamentals of implementation science is helpful for the successful and sustainable implementation of expert standards and for general knowledge transfer in nursing.

Facilitators, barriers, and guidance to successful implementation of multidisciplinary transitional care interventions: A qualitative systematic review using the consolidated framework for implementation research

Background

Multidisciplinary transitional care interventions aim to improve the coordination and continuity of healthcare during hospitalization and after discharge for patients with complex care needs related to physical, nutritional, or psychosocial status. Implementing such interventions is complex as they involve many stakeholders across multiple settings. Numerous studies have evaluated patients', family members', and healthcare professionals' experiences with multidisciplinary transitional care interventions, which can provide insight into facilitators and barriers to their implementation.

Objective

To provide an overview of facilitators and barriers to implementing multidisciplinary transitional care interventions, which could be considered before developing implementation strategies.

Design

A qualitative systematic review using the Consolidated Framework for Implementation Research.

Settings

Hospitals and primary care.

Participants

Adult patients admitted to a hospital, regardless of their diagnosis, as well as their family members and hospital and primary care healthcare professionals.

Methods

Embase, CINAHL, and Medline were searched for qualitative studies evaluating multidisciplinary transitional care interventions through patients', family members', and healthcare professionals' experiences and views from inception until June 2024. The methodological rigor was assessed with the Critical Appraisal Skills Program. We identified facilitators and barriers to the successful implementation of multidisciplinary transitional care interventions with the Consolidated Framework for Implementation Research. Facilitators and barriers were categorized into pre- or post-discharge or general factors.

Results

Twelve studies were included and appraised. We identified 79 factors, mostly linked to three domains of the Consolidated Framework for Implementation Research: Innovation, Inner setting, and Individuals involved. Facilitators included "comprehensive follow-up care needs assessment"(pre-discharge), "immediate, tailored follow-up care"(post-discharge), and "improved communication between stakeholders"(general). Barriers included "shortage of hospital beds" and "lack of time"(pre-discharge), "lack of available primary care professionals"(post-discharge), "inconsistencies of stakeholders' schedules" and "intervention costs"(general).

Conclusions

The factors identified could serve as a non-exhaustive inventory list to inspire readers who wish to implement a multidisciplinary transitional care intervention in their settings. Digital tools and alternative financing models might overcome cost and reimbursement issues, the increasing complexity of patient care, and shortcomings, such as the lack of available hospital beds or professionals. Further research should identify effective implementation strategies, considering the pre-, post-discharge, and general factors identified.

Registration

The protocol was registered in PROSPERO (CRD42023421423).

Tweetable abstract

Effective communication aids in implementing transitional care interventions, but patient care complexity and healthcare system pressures present challenges.

The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality

The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.

A Survey of Minimally Invasive Surfactant Use in the United States

Minimally invasive surfactant therapy (MIST) has become the standard of care in delivering surfactant noninvasively in many parts of the world, particularly throughout Europe; however, centers in the United States have been slower to adopt it. The most recent assessment of the use of MIST in the United States was in 2018 by Kurepa et al. Considering the increasing evidence favoring MIST, this paper reassessed the current rate of utilization and aims to examine barriers to MIST implementation.A web-based survey was distributed to approximately 4,500 individuals in the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine (AAP SoNPM) mailing list. The questions were aimed at addressing MIST usage in the United States, examining barriers for neonatology providers to implement MIST into their practice, and determining the use of sedation during the MIST procedure.Of the 381 respondents, 39% used MIST as part of their practice, which was an increase from 15% in 2018. The most prevalent barrier to implementation was the lack of procedural training. There was a large increase in the use of sedation for the procedure compared with 2018.MIST use among AAP SoNPM respondents has more than doubled since 2018; InSurE (INtubation-SURfactant delivery Extubation) remains the most prevalent method of surfactant delivery in non-intubated patients. The list of different types of barriers and comments provided by respondents can be a resource for units planning to implement MIST. · The usage of MIST in the United States.. · What are the barriers to MIST implementation?. · The usage of sedation during MIST procedure..

Vitamin D testing in pharmacies: Results of a federal screening campaign

Introduction

The convenient accessibility of pharmacies positions them as optimal venues for screening initiatives. There is growing public concern regarding vitamin D levels, particularly during the winter months in middle-and northern latitudes. This study aimed to assess vitamin D levels in early spring and to evaluate the feasibility of implementing a large-scale screening campaign within pharmacies.

Methods

This investigation was structured as a cross-sectional multicenter survey conducted in a routine care setting. Data collection was performed in a fully anonymized manner. An automatic fluorescent immunoassay system was utilized for point-of-care-testing, and both patient and provider questionnaires were developed. Quantitative data were analyzed descriptively. Both parametric- and nonparametric statistical tests were performed to analyze the data, ensuring robust results across different assumptions. A resulting maturity matrix for implementation was conceptualized.

Results

Over a two-week campaign, 62 community pharmacies conducted a total of 2770 vitamin D tests. All participants completed the questionnaire, and 45 pharmacists participated in a retrospective survey. Vitamin D deficiency was identified in 56.2 % of participants, while 25.2 % exhibited levels of insufficiency. A higher BMI was associated with lower vitamin D levels, whereas daily supplementation correlated with higher levels compared to intermittent or weekly dosing regimens. The vast majority of patients expressed high satisfaction with the services provided. Pharmacists valued the positive feedback from patients and expressed enthusiasm for further testing and the advancement of clinical pharmacy services. The resulting maturity matrix facilitates corporate implementation.

Conclusion

The implementation of a large-scale federal vitamin D screening campaign proved to be feasible and resulted in high levels of satisfaction among both patients and providers. The findings indicated significantly low vitamin D levels among participants. Pharmacists expressed a desire for an expansion of clinical pharmacy services in the future.Vitamin D testing in pharmacies: results of a federal screening campaign.

Personalisation at the Core of Success: Process Evaluation of the LISTEN Randomised Controlled Trial Evaluating a Personalised Self-Management Support Intervention for People Living With Long Covid

BACKGROUND

The development and evaluation of rehabilitation interventions designed to support people with Long Covid (LC) remains an important ongoing priority. Many people with LC experience episodic, debilitating symptoms that can reduce their ability to engage in all areas of activity. The Long CovId personalised Self-managemenT support co-design and EvaluatioN (LISTEN) trial co-designed and evaluated a personalised self-management support intervention to build confidence and support people to live better with LC. This paper describes the context, implementation, mechanisms of impact and impacts from the LISTEN intervention, in comparison with usual LC services accessed within the National Health Service (NHS).

METHODS

A mixed methods process evaluation was nested within the LISTEN pragmatic, multi-site, randomised controlled trial. Data were collected from sites in England and Wales between September 2022 and January 2024. Observations and focus groups with healthcare practitioners (HCPs) delivering the intervention were conducted to assess fidelity. Standardised implementation measures, focussed on intervention feasibility, acceptability and appropriateness, were gathered from HCPs and intervention participants. Semi-structured interviews were undertaken with a subset of participants across both trial arms. Data were analysed independently using descriptive statistics, or reflexive thematic analyses, and subsequently integrated, drawing upon the Consolidated Framework for Implementation Research v2.

FINDINGS

Thirty-six HCPs participated in the process evaluation, and 197 intervention participants completed standardised implementation measures. Across both trial arms, 49 participants took part in semi-structured interviews. Six integrated themes were constructed from all data sources describing and illustrating links between the context, implementation, mechanisms of impact and impacts: 'Delivery during uncertainty and ambiguity', 'Diversity and consistency of usual care', 'Drivers for self-care and the impact of self-generated expertise', 'Appropriate if unexpected support', 'Personalisation at the core of success' and 'A spectrum of change'.

CONCLUSION

The LISTEN intervention is an appropriate, feasible intervention for participants and HCPs. The intervention can be delivered to a high level of fidelity following training and with ongoing HCP support. Access, receipt and perceptions of NHS LC services were variable. Personalised, relational interventions, such as LISTEN, can foster favourable impacts on confidence, knowledge and activity and are acceptable and strongly recommended within LC rehabilitation services.

PATIENT OR PUBLIC CONTRIBUTION

The study was supported by a patient and public involvement and engagement (PPIE) group from project conception to study end. Using their lived expertise, seven people with LC supported accessible recruitment (e.g., materials), data collection (e.g., topic guides), data interpretation (e.g., theme construction and reviewing findings) and dissemination activities (e.g., online webinars).

TRIAL REGISTRATION

ISRCTN36407216, registered 27/01/2022.

Maternity staff views on implementing a national perinatal mortality review tool: understanding barriers and facilitators

OBJECTIVES

Perinatal death reviews investigate the causes of perinatal mortality, identify potentially avoidable factors, and may help prevent further deaths. This study aimed to identify barriers and facilitators to the implementation of a standardised perinatal mortality review tool in Irish maternity units by engaging with healthcare professionals about their opinions on the existing system and implementing a standardised system.

METHODS

This study involved semi-structured interviews with staff from three maternity units of various sizes in Ireland. Recruitment involved purposive and snowball sampling. Interviews took place from May to December 2022 and covered topics such as the existing perinatal mortality review process, staff experiences with reviews and proposed changes to the system. Thematic analysis was performed.

RESULTS

Participants (n=32) included medical and midwifery staff with varying levels of seniority and experience with perinatal mortality reviews. Four themes were identified: the review process, time challenges of reviews, institutional culture and staff needs. Our findings demonstrated that the review process was structured differently across units, with varying levels of staff involvement. Institution culture, leadership and transparency were highlighted as essential aspects of the review process. Reviews have an impact on staff wellbeing, emphasising the need for continued support.

CONCLUSIONS

Implementing a standardised perinatal mortality review system is viewed positively by staff, though addressing the highlighted barriers to change is important. A standardised perinatal mortality review tool and review process may help strengthen perinatal death reviews, provide more information and opportunity for involvement for bereaved parents and help reduce future perinatal deaths.

Coronary Computed Tomographic Angiography to Optimize the Diagnostic Yield of Invasive Angiography for Low-Risk Patients Screened With Artificial Intelligence: Protocol for the CarDIA-AI Randomized Controlled Trial

BACKGROUND

Invasive coronary angiography (ICA) is the gold standard in the diagnosis of coronary artery disease (CAD). Being invasive, it carries rare but serious risks including myocardial infarction, stroke, major bleeding, and death. A large proportion of elective outpatients undergoing ICA have nonobstructive CAD, highlighting the suboptimal use of this test. Coronary computed tomographic angiography (CCTA) is a noninvasive option that provides similar information with less risk and is recommended as a first-line test for patients with low-to-intermediate risk of CAD. Leveraging artificial intelligence (AI) to appropriately direct patients to ICA or CCTA based on the predicted probability of disease may improve the efficiency and safety of diagnostic pathways.

OBJECTIVE

he CarDIA-AI (Coronary computed tomographic angiography to optimize the Diagnostic yield of Invasive Angiography for low-risk patients screened with Artificial Intelligence) study aims to evaluate whether AI-based risk assessment for obstructive CAD implemented within a centralized triage process can optimize the use of ICA in outpatients referred for nonurgent ICA.

METHODS

CarDIA-AI is a pragmatic, open-label, superior randomized controlled trial involving 2 Canadian cardiac centers. A total of 252 adults referred for elective outpatient ICA will be randomized 1:1 to usual care (directly proceeding to ICA) or to triage using an AI-based decision support tool. The AI-based decision support tool was developed using referral information from over 37,000 patients and uses a light gradient boosting machine model to predict the probability of obstructive CAD based on 42 clinically relevant predictors, including patient referral information, demographic characteristics, risk factors, and medical history. Participants in the intervention arm will have their ICA referral forms and medical charts reviewed, and select details entered into the decision support tool, which recommends CCTA or ICA based on the patient's predicted probability of obstructive CAD. All patients will receive the selected imaging modality within 6 weeks of referral and will be subsequently followed for 90 days. The primary outcome is the proportion of normal or nonobstructive CAD diagnosed via ICA and will be assessed using a 2-sided z test to compare the patients referred for cardiac investigation with normal or nonobstructive CAD diagnosed through ICA between the intervention and control groups. Secondary outcomes include the number of angiograms avoided and the diagnostic yield of ICA.

RESULTS

Recruitment began on January 9, 2025, and is expected to conclude in mid to late 2025. As of April 14, 2025, we have enrolled 81 participants. Data analysis will begin once data collection is completed. We expect to submit the results for publication in 2026.

CONCLUSIONS

CarDIA-AI will be the first randomized controlled trial using AI to optimize patient selection for CCTA versus ICA, potentially improving diagnostic efficiency, avoiding unnecessary complications of ICA, and improving health care resource usage.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06648239; https://clinicaltrials.gov/study/NCT06648239/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/71726.

Scaling up low barrier wound care for people who use drugs: a mixed methods study

BACKGROUND

People who use drugs (PWUD) have long required wound care-a need that has become more urgent with the rise of xylazine, an animal tranquilizer in the street opioid supply associated with necrotic wounds. When PWUD visit the hospital for wound care, they often face discrimination from healthcare staff and leave the hospital before treatment completion. Low barrier wound care, community-based wound care that is grounded in harm reduction, is promising for meeting PWUD where they are and providing trustworthy, high quality care. Yet, access to low barrier wound care remains limited. This study explored determinants of and strategies for scaling up low barrier wound care for PWUD.

METHODS

We utilized a prospective sequential exploratory mixed methods design, including semi-structured 1:1 interviews, community advisory board (CAB) meetings, and an online survey. The study was conducted from April 2024-September 2024 in Philadelphia, Pennsylvania and surrounding regions. We included wound care providers, administrators, and recovery specialists of low barrier sites with walk-in, flexible services and harm reduction approaches. The interviews identified determinants of scaling up low barrier wound care, guided by the Consolidated Framework for Implementation Research. We then facilitated CAB meetings and conducted a survey of CAB members to identify community-generated implementation strategies and assess acceptability, feasibility, and appropriateness of CAB-generated strategies. We also generated evidence-based implementation strategies using the Expert Recommendations for Implementing Change compilation.

RESULTS

Participants identified many barriers, including stigma, social needs, local policies, unstable funding, lack of specialized knowledge, and unstandardized evidence. Promising implementation strategies include using mass media to address stigma, developing resource sharing agreements between sites, revising professional roles to spread knowledge, and building academic partnerships to develop evidence. The most acceptable, feasible, and appropriate strategy rated by the CAB was offering social needs services (e.g., food, showers) within low barrier wound care sites.

CONCLUSIONS

Many factors at different levels influence the availability and quality of low barrier wound care for PWUD. Our results suggest that communities would benefit from a local needs assessment to identify and tailor strategies for scaling up care. Future work will test the effectiveness and implementation of identified strategies.

Exploring the facilitators and barriers to achieving universal health coverage in Uganda: a qualitative study of the free healthcare policy

BACKGROUND

Critical variations often occur between a state's initial public policy goals and its implementation outcomes. After two decades, the implementation of the free healthcare policy in Uganda has not achieved the desired outcomes, and there is a lack of comprehensive contextual analysis applying implementation science approaches in the identification of barriers and facilitators. This study explores barriers and facilitators to the implementation of the free healthcare policy, drawing on the retrospective experiences of policymakers, policy advocates, policy supporters or influencers, policy implementers, and policy beneficiaries.

METHODS

We employed an exploratory qualitative study design and conducted 27 semi-structured interviews with key informants and 16 focus groups with users. Perspectives on implementation over time were collected by incorporating questions relating to the policy implementation journey from inception to 2023. The Consolidated Framework for Implementation Research guided data analysis to categorize and examine the barriers and facilitators to implementation. Two coders independently coded the data, which were thematically analysed with NVivo.14.

RESULTS

A total of five main factors were identified, synthesized, and categorized as barriers and facilitators with overlaps, namely: (i) financial resources, (ii) medicines and supply system, (iii) health human resources, (iv) infrastructure and functionality, and (v) equity and the FHP Implementation.

CONCLUSIONS

Findings illustrate that policy implementation gaps are due to limited resources, political will that does not translate into sufficient allocation of funds, and incremental policy shifts that are not driving meaningful improvement in the health system. The findings explain why the free healthcare policy implementation has been unsuccessful and highlight the importance of investing in resources to support meaningful progress towards universal health coverage.

Patient experiences with person-centred and integrated chronic care, focusing on patients with low socioeconomic status: a qualitative study

BACKGROUND

The effectiveness of single disease management programmes in general practice may be limited for patients with low socioeconomic status (SES), as these programmes insufficiently take into account the specific problems and needs of this population. A person-centred integrated care (PC-IC) approach focusing on individual patient's needs and concerns could address these problems.

AIM

To explore experiences of patients with (multiple) chronic diseases with regard to the acceptability of a general practice-based PC-IC approach, with a focus on patients with low SES, and to establish which modifications are needed to tailor the approach to this group.

DESIGN AND SETTING

In 2021, a feasibility study in seven general practices in the Netherlands was carried out. The healthcare professionals provided care based on a PC-IC approach for patients with diabetes, chronic respiratory diseases and/or cardiovascular disorders. Patients were followed for 6 months.

METHOD

This was a qualitative study using focus group discussions, in-depth interviews, and semi-structured telephone interviews in a total of 46 patients with chronic diseases and multimorbidity, including 31 patients with low SES.

RESULTS

An overall positive experience of participants with the PC-IC approach was observed. Discussing their health made patients feel they were being taken more seriously and seen as a unique individual, and it provided the opportunity to discuss their life and health concerns. Recommended adaptations of the PC-IC approach for patients with low SES include creating materials that are clear and easy to understand and offering communication training for healthcare professionals.

CONCLUSION

The PC-IC approach seems helpful for patients with chronic diseases, provided that it is tailored to their skills and abilities. Several modifications for patients with low SES were suggested.

Implementation evaluation of a community-based youth participatory action research program

Youth participatory action research (YPAR), a method in which young people are engaged as research partners and change agents, offers a powerful paradigm to promote empowerment and liberation. YPAR interventions have been applied in diverse settings to address various issues. Identifying barriers and facilitators to implementing YPAR programs may increase the scope and impact of this study. Implementation and dissemination science (IDS) utilizes structured evaluation frameworks to assess determinants of intervention uptake, utilization, and sustainability. IDS has long been utilized in community psychology; yet applications to YPAR are limited. In the present study, we use the Consolidated Framework for Implementation Research (CFIR) to evaluate a community-based YPAR intervention. Drawing on qualitative and quantitative data collected from multiple informants (e.g., participants, facilitators, and research team members) throughout the implementation period, we describe key barriers and facilitators related to programming. In addition, we present preliminary implementation outcomes (e.g., feasibility, acceptability) from our intervention. In describing these analyses, we center IDS as a key approach for rigorous evaluation of YPAR and similar community-based programs.

A cross-sectional online survey on oncologists' attitudes toward and experiences with providing patients with audio recordings of their medical encounters

Providing patients with audio recordings of their medical encounters, termed consultation recordings, has shown promising benefits, especially for patients with cancer. While patients favor these recordings, international research indicated that physicians have mixed feelings. To date, research specific to Germany remains limited. This study investigated German oncologists' attitudes and experiences through a nationwide cross-sectional quantitative online survey, informed by semi-structured interviews. Attitudes, prior experiences and desire for consultation recordings were assessed. Data was analyzed using descriptive statistics and subgroup analyses. Ninety-four physicians participated, with about half expressing a generally positive attitude, though overall attitudes were mixed. Expected benefits included improved patient recall and communication, while concerns centered around potential misuse of recordings, data confidentiality, and increased legal risks. Experiences were limited, with 12% reporting previous use. Fourteen percent expressed a willingness to offer recordings in future and 31% were undecided. This study highlights cautious openness among German oncologists, tempered by concerns over data security and legal implications, which may hinder adoption. This could be addressed by providing sound evidence regarding benefits and concerns, and enabling positive experiences. Further research should include feasibility testing in routine cancer care and re-evaluation of these results in representative samples and other specialties.

Barriers, facilitators and implementation strategies to implement 'patient's own medication' and 'self-administration of medication' in hospitals

BACKGROUND

Implementing patient's own medication (POM) and self-administration of medication (SAM) has several benefits for safe and sustainable medication use, including enhanced patient empowerment reduced workload for hospital staff and decreased medication waste. Despite positive attitude of stakeholders, the upscaling of these strategies in hospitals remained limited. This study aimed to (i) identify barriers and facilitators for implementing POM and SAM and (ii) develop implementation strategies to address these.

METHODS

Semistructured interviews were conducted among healthcare providers involved in the implementation of POM and SAM in 10 Dutch hospitals. The study population encompassed (hospital and outpatient) pharmacists, pharmacy technicians, nurses, and (ward) physicians. The topic guide was based on COM-B model. Barriers and facilitators were identified with thematic content analysis and were categorized to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies were selected based on identified barriers through the CFIR- Expert Recommendations for Implementing Change (ERIC) tool and identified strategies were clustered into predefined focus areas to develop implementation targets.

RESULTS

The 23 participants generally expressed a positive attitude towards implementation of POM and SAM. Themes reflecting facilitators related to (i) multiple benefits for patients, hospital, and society, (ii) a dedicated multidisciplinary implementation team, (iii) an iterative implementation process, whereas barriers related to (iv) substantial and invasive workflow changes, (v) reluctance to change responsibilities of healthcare providers, and (vi) unclear regulations and reimbursement. The CFIR-ERIC tool highlighted 57 implementation strategies in nine key focus areas to support the implementation of POM and SAM.

CONCLUSION

To implement POM and PAM successfully, strategies relating to involving stakeholders, changing infrastructure, and using an iterative implementation process are required.

Stakeholders and Contextual Factors in the Implementation of Assistive Robotic Arms for Persons With Tetraplegia: Deductive Content Analysis of Focus Group Interviews

BACKGROUND

Tetraplegia imposes significant challenges on affected individuals, caregivers, and health care systems. Assistive technologies (ATs) such as assistive robotic arms have been shown to improve the quality of life of persons with tetraplegia, fostering independence in daily activities and reducing caregiver burden. Despite potential benefits, the integration of AT innovations into daily life remains difficult. Implementation science offers a systematic approach to bridge this know-do gap.

OBJECTIVE

This study aimed to (1) identify and involve relevant stakeholders; (2) identify relevant contextual factors (barriers and facilitators); and (3) suggest a general outlook for the implementation of AT, specifically an assistive robotic arm, into the everyday private lives of individuals with tetraplegia in Switzerland.

METHODS

A qualitative design was used, involving 3 semistructured online focus group interviews with 8 stakeholder groups, including persons with tetraplegia as well as those who could provide perspectives on engineering or technology, legal matters, nursing or care, therapy, social counseling, social insurance, and political considerations. The interviews were analyzed using the Focus Group Illustration Mapping tool, and the data were aligned with the domains of the Consolidated Framework for Implementation Research.

RESULTS

3 focus group interviews comprising 22 participants were conducted, and data were mapped onto 21 constructs across the Consolidated Framework for Implementation Research domains. Identified barriers were customization to users' needs, safety concerns, and financing issues for the high AT costs. The collaboration with different stakeholders, including those who provided perspectives on political engagement, proved crucial. Identified facilitators included the enhancement of autonomy for persons with tetraplegia, improvement of quality of life, reduction of caregiver dependency, and addressing health care labor shortages. The implementation outlook involved the formation of an experienced team and the development of an implementation plan using hybrid type 1 and type 2 designs that incorporate both qualitative and quantitative implementation and innovation outcomes.

CONCLUSIONS

Robotic arms offer promising benefits in terms of improved participation for users, while high costs and regulatory complexities as to who will assume these costs limit their implementation. These findings highlight the complexities involved in implementing AT innovations and the importance of addressing contextual factors. A specific framework for the implementation of AT is needed to ensure the successful integration in Switzerland and other countries with comparable social and health insurance systems.

Facilitators and Barriers for a Stepped Care Approach to Promote Return to Work of Employees with Distress: A Multi-perspective Qualitative Study

PURPOSE

A stepped care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the potential facilitators and barriers for a stepped care approach to promote RTW of employees with distress, from the perspective of employees, employers, and occupational physicians.

METHODS

A qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors, and two focus groups with 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains.

RESULTS

Themes were constructed belonging to either the implementation or the content of the stepped care approach, falling within the CFIR domains "innovation," "outer setting," "inner setting," and "characteristics of the individual." From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments, and the RTW coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped care approach, integrating the approach in the current RTW system, and low digital skills.

CONCLUSION

Both facilitators and barriers were found for the implementation of the stepped care approach. This underlines the importance of an adaptive implementation strategy that takes into account workplace dynamics and tailored approaches to support the stakeholder groups' needs.

TRIAL REGISTRATION

ISRCTN: 90663076. Registered on October 5, 2023.

Building Seamless Care Transitions: Connecting Physical Therapy to Community Resources for Older Adults With Arthritis

Background and Purpose:

Physical therapists struggle to ensure continuity of care for older adults with arthritis and other chronic conditions at the completion of episodes of care. With osteoarthritis affecting 25 million older adults and causing activity limitations in at least 50% of cases, there is a critical need for a systematic approach to bridge the community-clinical gap between physical therapy and community-based organizations (CBOs) that offer evidence-based programming and address health-related social needs. This administrative case report presents a technology-enabled model for supporting patients’ transition from physical therapy to community-based programs, transforming traditional siloed care into an integrated system through a coordinated community care hub (CCH).

Case Description:

A physical therapist, Sarah, completes treatment for a 68-year-old patient with bilateral knee osteoarthritis. While the patient has made significant progress, they would benefit from ongoing community-based exercise and falls prevention programming. The patient also faces social isolation and food insecurity, which could undermine therapy gains. Sarah lacks an efficient way to connect the patient with appropriate services and follow up on progress. To address this use case, we developed a model linking health care providers with CCHs. The CCHs are local entities that coordinate networks of CBOs addressing health-related social needs and connect patients to evidence-based programs.

Outcomes:

Our model, set to pilot in 2024, streamlines referrals from physical therapy to CBOs and programs through:

Discussion:

This approach offers a practical solution to a common challenge faced by physical therapists in managing the long-term care of older adults with arthritis. By leveraging technology to facilitate these community-clinical connections, we reduce the administrative burden on clinicians while improving both health outcomes and social support for patients. This model has the potential to transform how physical therapists ensure continuity of care and could be adapted for other chronic conditions.

Identifying and Addressing the Missing Links Between Research, Policy, and Practice in Autism Research: Lessons From Early Autism Screening and Intervention Research

The evidence base on autism diagnosis and intervention has grown exponentially in the past two decades, but there continue to be gaps in the path connecting research, policy, and practice. For example, although standardized autism screening tools have been shown to be helpful for identifying early signs of autism and facilitating early diagnosis, many pediatricians in the United States do not use them as recommended. Similarly, despite the sound evidence supporting Naturalistic Developmental Behavioral Interventions, they are seldom used in early intervention practice. This commentary examines the nature of these gaps using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, with a focus on the role of "big P" policies, which include legislation and agency regulations, and "little p" policies, which include guidelines set by professional organizations. Efforts to bridge the gap between research and practice through policy offer the potential for improving the lives of those on the autism spectrum through early detection and intervention programs and beyond.

Determinants of implementing the 15-method in Danish general practice using the consolidated framework for implementation science

BACKGROUND

Excessive alcohol consumption is a significant global health issue, often unaddressed in primary care. The 15-method, a three-step opportunistic screening and treatment tool premised on Motivational Interviewing and integrated within the Screening, Brief Intervention and Referral to Treatment framework, offers a structured approach for healthcare professionals to identify and treat alcohol-related problems. The present study aimed to assess healthcare professionals' perceptions of determinants for early-stage implementation of the 15-method in Danish general practice and to classify these determinants using the Consolidated Framework for Implementation Research (CFIR).

METHODS

This qualitative study involved individual interviews and group interviews with general practitioners and nurses (N = 28) from 12 general practices participating in the Identification and Treatment of Alcohol Problems in Primary Care (iTAPP) study, a stepped-wedge cluster randomized controlled trial evaluating the effectiveness of the 15-method in Danish general practice. Interviews were semi-structured, guided by the CFIR framework, and analyzed using directed content analysis. Determinants were rated for their influence on implementation.

RESULTS

Key facilitators included the 15-method's adaptability, strong evidence base, relative advantage, and compatibility with existing practices. Barriers included structural characteristics in the practices and local conditions. A central finding revealed a tension between patients' motivation and healthcare professionals' opportunities and capabilities to deliver the 15-method. Mixed determinants highlighted the complexity of implementing the 15-method across diverse practices.

CONCLUSION

Implementing the 15-method in Danish general practice is feasible but requires addressing specific barriers and leveraging facilitators. A multifaceted implementation strategy tailored to individual practices may be necessary to address the variations in contexts and resources across different practices with an emphasis on increasing healthcare professionals' capabilities and opportunities to deliver the intervention.

Challenges in Implementing Artificial Intelligence in Breast Cancer Screening Programs: Systematic Review and Framework for Safe Adoption

BACKGROUND

Artificial intelligence (AI) studies show promise in enhancing accuracy and efficiency in mammographic screening programs worldwide. However, its integration into clinical workflows faces several challenges, including unintended errors, the need for professional training, and ethical concerns. Notably, specific frameworks for AI imaging in breast cancer screening are still lacking.

OBJECTIVE

This study aims to identify the challenges associated with implementing AI in breast screening programs and to apply the Consolidated Framework for Implementation Research (CFIR) to discuss a practical governance framework for AI in this context.

METHODS

Three electronic databases (PubMed, Embase, and MEDLINE) were searched using combinations of the keywords "artificial intelligence," "regulation," "governance," "breast cancer," and "screening." Original studies evaluating AI in breast cancer detection or discussing challenges related to AI implementation in this setting were eligible for review. Findings were narratively synthesized and subsequently mapped directly onto the constructs within the CFIR.

RESULTS

A total of 1240 results were retrieved, with 20 original studies ultimately included in this systematic review. The majority (n=19) focused on AI-enhanced mammography, while 1 addressed AI-enhanced ultrasound for women with dense breasts. Most studies originated from the United States (n=5) and the United Kingdom (n=4), with publication years ranging from 2019 to 2023. The quality of papers was rated as moderate to high. The key challenges identified were reproducibility, evidentiary standards, technological concerns, trust issues, as well as ethical, legal, societal concerns, and postadoption uncertainty. By aligning these findings with the CFIR constructs, action plans targeting the main challenges were incorporated into the framework, facilitating a structured approach to addressing these issues.

CONCLUSIONS

This systematic review identifies key challenges in implementing AI in breast cancer screening, emphasizing the need for consistency, robust evidentiary standards, technological advancements, user trust, ethical frameworks, legal safeguards, and societal benefits. These findings can serve as a blueprint for policy makers, clinicians, and AI developers to collaboratively advance AI adoption in breast cancer screening.

TRIAL REGISTRATION

PROSPERO CRD42024553889; https://tinyurl.com/mu4nwcxt.

Evidence-based general practice: a scoping review

BACKGROUND

Evidence-based medicine(EBM) is widely used across various disciplines globally. However, in general practice, we need a more person-centered approach rather than a disease-centered one. The differentiation of evidence-based general practice (EBGP) is essential. This scoping review aims to extract a potential definition of EBGP and uncover its characteristics in implementation.

METHODS

We conducted a comprehensive search across three databases - PubMed, Embase, and Cochrane Library - spanning from the inception of these databases to September 24, 2023. The inclusion criteria encompassed studies focusing on EBM in general practice, involving general practitioners as study participants, and reporting any aspects related to providing evidence-based care. Our screening process involved evaluating titles, abstracts, and full texts to extract definitions and characteristics from all relevant records discussing EBGP. These identified characteristics were then categorized and thematically grouped following the guidelines outlined in the Consolidated Framework for Implementation Research (CFIR).

RESULTS

We initially retrieved 20,263 records from the original search. Among these, 40 records aligned with our inclusion criteria. The majority of these records took the form of reviews, qualitative studies, comments, cross-sectional surveys, or editorials. From these 40 studies, we extracted 33 unique characteristics of EBGP. Subsequently, these characteristics were thematically grouped into 19 categories, which fell under five overarching themes: evidence base, GP's role, person's role, care process, and care environment.

CONCLUSIONS

We propose the following definition for EBGP: Applying a combination of the best available evidence, integrated within the inner and outer contexts of general practice, person preferences, and the expertise of the general practitioner to formulate shared, person-centered decisions aimed at holistic care. This definition provides a solid foundational framework for the development of EBGP guidelines and policies.

REGISTRATION NUMBER

https://doi.org/10.17605/OSF.IO/2UNX7 .

Difference and subordination - the epistemic struggles of collaborative knowledge production in the field of mental health

BACKGROUND

Collaborative or co-productive approaches in the field of mental health care research are often legitimized by the argument that researchers with lived experience of mental health crisis and disability (= LE) produce different knowledge as compared to those without these experiences At the same time, there is a lack of studies that report on the underlying collaborative processes and on how these processes affect the knowledge that is being produced. This manuscript describes a collaborative research process and how this process impacted the knowledge produced.

METHODS

The collaborative research process entailed a multi-step coding process, using a variant of thematic analysis. To facilitate comparison, two code systems were produced, one by researchers with and the other by researchers without LE of mental health crisis and disability. Subsequently, the code systems of these two sub-teams were integrated into a single code system. To evaluate the potential differences between the code formations of the two sub-teams as well as the effects of their integration, three focus groups suceeded, composed of 1) psychology students as well as researchers 2) with and 3) without LE, whose results are at the core of this manuscript.

RESULTS

The focus group participants described extensive differences between the code formation of the researchers with and without LE - first in form, but also more substantially in the contents of both systems - corresponding to two distinct logics for understanding the implementation of PSW: an "institutional" and "interactional" logic. The integration process of both code systems was described as invasive, resulting in a final code system that more closely resembled the primary code system of the researchers without LE.

CONCLUSION

The distinct logic of the two code systems can be thought of as distinct but complementary positions on the topic of PSW implementation. Such an explanation, however, falls short, as it silences the power relations and diverging interests and positions of the researchers involved. This is supported by what resulted from the integration of both code systems, resulting in the continuation of the logic of the researchers without LE. It is concluded that epistemic struggles and their knowledge politics require greater attention in the context of collaborative mental health research.

A clinical trial evaluating pharmacist-guided self-management of hypertension among veterans with CKD, rationale and study design

RATIONALE & OBJECTIVE

Chronic kidney disease (CKD) associates with high morbidity and mortality due to CKD progression and cardiovascular disease (CVD). Blood pressure (BP) lowering reduces the risk of CVD and CKD progression. Despite the large number of BP medications available, a significant proportion of patients with CKD have BP above the goal. The current practice involves licensed providers performing medication titrations to achieve BP goals and is associated with limited patient engagement. Here, we evaluate the effectiveness of pharmacist-guided patient-driven titration of BP medications in CKD.

STUDY DESIGN

Randomized clinical trial.

SETTING & PARTICIPANTS

One hundred and sixty Veterans with uncontrolled hypertension and either stage 2 CKD with albuminuria or stage 3 or 4 CKD are recruited from the Iowa City VA Healthcare system.

INTERVENTIONS

Subjects are randomized to the pharmacist self-guided management arm or the self-monitoring arm for 12 months.

OUTCOMES

This is a mixed methods study. The primary outcome is change in standardized office systolic BP at 12 months. Secondary outcomes include change in standardized office diastolic BP, change in home systolic and diastolic BPs, change in conventional office systolic and diastolic BPs, and emergency room visits for uncontrolled hypertension or hypertensive emergency. The study team will conduct semi-structured interviews to evaluate the acceptability and the adherence to the self-management approach to Veterans and to assess potential barriers and facilitators to implementation of the self-management approach.

TRIAL REGISTRATION

NCT05546099.

Qualitative Study of the Context of Health Information Technology in Sepsis Care Transitions: Facilitators, Barriers, and Strategies for Improvement

OBJECTIVE

To examine how health information technology (HIT) supports timely post-acute home health and outpatient care for sepsis survivors by identifying facilitators, barriers, and proposed strategies.

DESIGN

Qualitative descriptive study.

SETTING AND PARTICIPANTS

Clinicians, care coordinators, sepsis coordinators, and administrators from 5 US health systems (hospitals and outpatient clinics) and affiliated home health care (HHC) agencies.

METHODS

We conducted semi-structured interviews, which were recorded, transcribed, and analyzed using thematic analysis with both deductive and inductive coding. Deductive coding was guided by the Consolidated Framework for Implementation Research to systematically assess barriers and facilitators of the intervention. The analysis achieved more than 90% interrater reliability, and member checking enhanced trustworthiness. After coding was finalized, a query was generated to identify electronic health record (EHR)-related themes that support or hinder health information management in electronic systems.

RESULTS

Sixty-one interviews with 91 participants identified 17 themes related to HIT's role in care transitions for sepsis survivors. HIT facilitated sepsis identification, documentation, communication, information sharing, care coordination, and quality monitoring during hospital-to-home transitions. Barriers included missing, delayed, or inaccessible information across disparate EHR systems. Proposed strategies include establishing interoperable EHR systems and leveraging HIT tools to improve identification, communication, and care coordination for timely follow-up care, with continuous monitoring of functionality.

CONCLUSIONS AND IMPLICATIONS

HIT plays a central role in care transitions, improving information sharing, communication, and coordination, ultimately enhancing patient outcomes and safety. Administrators can improve data integration and quality monitoring with interoperable systems, and policymakers can promote adoption through financial incentives. The advancement of technologies, including HIT tools, may offer opportunities to further optimize sepsis identification, communication, and care coordination, promoting seamless care transitions.

Implementation of two transdiagnostic interventions based on emotional regulation for professionals who treat alcohol addiction in the Spanish mental health system: A multicenter mixed methods pilot study protocol

Emotional dysregulation has been considered a transdiagnostic factor and an important determinant of craving and relapse in alcohol addiction. Dialectical Behavior Therapy (DBT) and the Unified Protocol (UP) are two transdiagnostic emotional regulation programs with good efficacy in improving alcohol addiction severity. However, an important barrier encountered when implementing evidence-based interventions in drug addiction services is the inadequate training received by professionals. This study aims to evaluate the effect of a dissemination and pilot implementation initiative of DBT and UP among professionals treating alcohol addiction in the national Spanish healthcare system.

METHODS

The study will be conducted in two phases using a mixed methods design. In phase 1, two 3-day training workshops (DBT and UP; 40 hours total) will be provided by experts to at least 130 healthcare workers from three Spanish regions. Participants will be randomly assigned to receive either DBT or UP training first, followed by the other. The study will include a range of quantitative outcomes including beliefs about alcohol abuse, burnout, self-efficacy, attitudes towards evidence-based interventions, organizational variables, acceptability and intention to use the interventions, barriers to implementation, and knowledge acquisition. The appropriateness of the interventions in real community settings will be qualitatively assessed. In phase 2, at least 30 trained professionals will be randomly assigned to implement DBT or/and UP 3-month group interventions in their workplaces with alcohol addiction patients. Quantitative outcomes will include acceptability, feasibility, appropriateness, fidelity and sustainability of the interventions, barriers to implementation, as well as qualitative descriptions of barriers and facilitators during the implementation process.

DISCUSSION

To our knowledge, this is the first study to evaluate a pilot implementation of transdiagnostic psychological interventions based on emotion regulation to treat alcohol addiction. Findings of this study will inform of factors influencing the successful implementation of DBT and UP in community-based addiction services.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06366100.

Capabilities, opportunities and motivations within Australian community pharmacy to deliver clinical care standard-aligned care for knee osteoarthritis: A mixed-methods evaluation

OBJECTIVE

To evaluate the capabilities, opportunities, and motivations of community pharmacists and pharmacy assistants to deliver osteoarthritis (OA) care, aligned with the Australian Osteoarthritis of the Knee Clinical Care Standard.

METHOD

Quantitative data from pharmacists and pharmacy assistants working in Australian community pharmacies were collected via e-surveys. Behaviour-change theory-informed items measured pharmacists' capabilities, opportunities, and motivations to provide Standard-aligned care. Pharmacy assistants reflected on their perceived role in OA care through focus groups.

RESULTS

407 pharmacists and 148 pharmacy assistants responded. Most pharmacists (>80%) reported high motivations to engage in OA care, with >80% agreeing that five of the seven quality statements were within their scope of practice. Across quality statements, median feasibility to deliver Standard-aligned care (measured on 9-point numeric rating scale; 1 = not at all feasible; 9 = highly feasible) ranged from 6-7 within knowledge, 5-7 within workload, 6-7 within workflow, 8 within pharmacy layout/infrastructure, and 1-5 in absence of additional remuneration. More time-consuming care (e.g., self-management support, patient review) was rated less feasible. Adjusted linear regression models identified that perceived workload and workflow feasibility increased when more pharmacists were on duty (R2: 0.02-0.11). Three themes (with sub-themes) emerged from pharmacy assistants' qualitative data (n = 13): 1) professional activities related to OA care; 2) capabilities and scope of practice; and 3) managing workflow and alleviating workload pressures.

CONCLUSION

While pharmacists self-reported high motivation and capabilities to deliver Standard-aligned OA care, implementation feasibility will likely depend on addressing workload, workflow, and, particularly, remuneration barriers. Role delineation and training for pharmacy assistants may support better OA care within community pharmacies.

Starting with the End in Mind: Recommendations to Optimize Implementation of a Novel TBI Classification from the 2024 NINDS TBI Classification and Nomenclature Workshop's Knowledge to Practice Working Group

The Knowledge to Practice Working Group (K2P WG) was one of six expert groups convened in early 2023 to plan the 2024 National Institute of Neurological Disorders and Stroke Traumatic brain injury (TBI) Classification and Nomenclature Workshop. Recognizing that implementation of revised classification systems is essential to achieve intended impact, the K2P WG's key aims were to foster shared understanding of knowledge translation (KT), build capacity for implementation of a revised TBI classification system, identify and prioritize KT actions, implementation steps and audiences; and make recommendations to advance implementation. The cornerstone of this work was a focused survey to identify "who needs to do what differently," while prioritizing potential implementation actions. Survey findings, dialogue with other working groups, stakeholder discussions, and public feedback were also utilized to support implementation of the revised Clinical, Biomarker, Imaging-Modifiers and retrospective TBI classification system. Forty researchers across five working groups responded to the survey (Response Rate = 59.7%). Fifty-two unique implementation actions were identified. The top 15 priorities across the five working groups comprised six pertaining to clinical practice (e.g., change Glasgow Coma Scale [GCS] assessment); seven focusing on research (e.g., develop tools for measuring psychological and environmental factors); and one each on lived experience (simplified language for patients and families) and other settings (insurance company support for biomarker testing). Twenty-seven stakeholder groups and 18 target settings were identified as being most impacted by the revised classification system. Key recommendations included: develop guidelines based on systematic reviews, clearly explain the rationale for the change, develop implementation toolkits with input from all stakeholders, and embed the new classification in a learning health system database to facilitate implementation strategies based on audits, feedback, and cost-effectiveness analyses.

Engaging community pharmacy in tuberculosis case detection (ENHANCE): a study protocol for an implementation study in Indonesia

INTRODUCTION

A significant number of possible tuberculosis (TB) missing cases are still reported globally. Pharmacies are reported as a significant first point of contact for people with TB. Unfortunately, the practice of TB detection in pharmacies is still lacking. Therefore, this study aims to implement and evaluate a community pharmacy program for TB case finding in a systematic and structural approach.

METHODS

An implementation study will be piloted in Bandung City, Indonesia, from February to November 2025. The program will engage pharmacy personnel in screening, educating, and referring people with presumed TB to community health centers (CHCs) for further diagnostic work-up. This study will involve selecting 20 pharmacies and 4 CHCs. Sequential research activities will be performed, incorporating quantitative and qualitative approaches, i.e., (1) building a coalition, (2) developing a conceptual program, (3) program socialization and educational intervention, and (4) program implementation and evaluation. The program outcomes will be reached according to the sequential research activities: (1) a joint agreement among the key actors and implementers, (2) a conceptual program for implementation, (3) improved capacity of implementers and availability of practice aids and system for the implementation, (4) the effectiveness of the program implementation. The Consolidated Framework for Implementation Research will be used as a framework in this study. Descriptive and multivariable analyses will be used for quantitative data, while thematic analysis will be used for qualitative data. Finally, an implementation outcome will be comprehensively analyzed, considering the quantitative and qualitative data analyses for the key factors of the successful program.

Advancing implementation of single session interventions in schools: a protocol for a qualitative study

BACKGROUND

Schools are one of the most common settings in which youth seek mental health services, yet existing school-based mental health interventions are often difficult to implement due to time, cost, and staffing limitations. Digital, self-administered Single Session Interventions (SSIs) are evidence-based supports that are intentionally structured to deliver a clinically-meaningful dosage of evidence-based content within one session. Although multiple studies have demonstrated the clinical effectiveness of school-based SSIs, there have been no systemic efforts to understand how SSIs can be practically implemented in schools. The goal of this project is to partner with students, parents, and school staff to identify factors that impact the implementation of SSIs and understand how SSIs can be sustainably integrated as mental health supports into school mental health infrastructure.

METHODS

We will conduct focus groups (five groups, total n = 35-45) among community members (i.e., students, parents/caregivers, teachers, school administrators, and school mental health providers) to assess perceived facilitators and barriers to the effective implementation of evidence-based SSIs in schools (Aim 1). We will then work in partnership with community members (n = 10-15) to co-design multi-level implementation strategies (i.e., student-directed, staff-directed, system-directed) for increasing uptake and promoting sustainability of school-based SSIs (Aim 2). We will use inductive coding to thematically analyze qualitative data from group sessions. This study is being conducted within the Lake Washington School District in the Seattle, Washington region.

DISCUSSION

The proposed project will be the first to investigate facilitators and barriers to real-world implementation of SSIs in schools and strategies to improve implementation. Future studies may test the effectiveness of the generated implementation strategies on outcomes such as SSI uptake over time.