Ten years of implementation outcomes research: a scoping review

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.

Grey literature scoping review: a synthesis of the application of participatory methodologies in underrepresented groups at an elevated risk of dementia

BACKGROUND

Diverse populations are more exposed to life course influences on adverse ageing, including brain ageing. Research into dementia in the United Kingdom inadvertently lacks diversity. Therefore, there is a need for more inclusive dementia research, developed in a way to ensure those who are currently missing from standard health data are represented. This may warrant the use of co-creation (emphasising collaborative creation and solution development), drawing on participatory methodologies in healthcare, research and service delivery.

METHODS

This study presents a scoping review of grey literature using Arksey and O'Malley's methodology. Literature was sourced from the Patient Experience Library and supplemented by a targeted Google Scholar search, employing snowball sampling to identify additional materials. The search strategy incorporated keywords such as "marginalised", "vulnerable", "disadvantaged" and participatory terms like "co-creation" and "co-design". Two reviewers independently screened and extracted key higher-level attributes (e.g., type of report, purpose of the activity (design), participating stakeholders/target populations) as well as data related to "co-creation process dimensions" and "participation levels".

RESULTS

Our review identified 30 grey literature reports on participatory methodologies among underrepresented groups living with or at elevated risk of dementia, covering diverse locations within the United Kingdom. The reported activities aimed to enhance healthcare and social services through stakeholder participation. Our findings highlight a focus on multi-stakeholder collaborative action as the dominant co-creation dimension identified. However, there was also a notable absence of more inclusive methodologies, with consultation being the most commonly used approach.

CONCLUSIONS

Our scoping review highlights the value of grey literature in understanding participatory methodologies for underrepresented populations at risk of or living with dementia. It reveals there is still a potential need to shift from mere consultations to sustained partnerships, promoting meaningful inclusion and greater ownership of (health) outcomes among these populations.

ETHICS AND DISSEMINATION

Ethical approval was not required for this grey literature scoping review.

CLINICAL TRIAL NUMBER

Not applicable.

Feasibility of a School-Based Suicide Prevention Gatekeeper Intervention and an Implementation Intervention (Project ROS): Study Protocol

BACKGROUND

Despite the high risk of suicidal behaviour in youth, there is a lack of evidence-based interventions within school settings for those who are at increased risk. The Project ROS (in Realise, Convince and Refer in Danish Realiser, Overbevis og Send videre) will train teaching staff and implement QPR (Question, Persuade, Refer), a suicide prevention gatekeeper intervention supported by an implementation intervention at specialised schools (FGU) in Denmark.

AIM

To determine the feasibility of delivering school-based QPR (Question, Persuade, Refer) gatekeeper training, supported by an implementation intervention based on evidence-based implementation strategies.

METHODS

A two-phase case study with a feasibility hybrid evaluation design. The evaluation will include a multimethod approach including pre-, post- and follow-up survey measurements, field observations and semi-structured single and focus group interviews.

DISCUSSION

A multimethod design will be used to validate the results. The use of methodological triangulation will help to reduce bias and deficiencies compared to using a single-method design.

Evaluating spoke facilitation costs of implementing TelePain in the Veterans Health Administration

BACKGROUND

The high prevalence and significant morbidity and mortality associated with chronic pain among veterans has made expansion of pain services within the Veterans Health Administration (VHA) a key priority. TelePain, in which services are provided via telehealth from central "hub" sites to patients at decentralized "spoke" sites, is one such model with positive implementation findings to date. However, the staff effort and cost of implementation have yet to be examined when considering TelePain or similar virtual hub-and spoke models of specialty pain care, information that is critical for expansion of services.

METHODS

Using an established time-based activity tracker designed for implementation facilitation, study staff tracked minutes spent on implementation activities at 11 spoke sites. Annual salaries were extracted to calculate an average cost per minute for each personnel type. Costs per personnel minute were combined with activity data to calculate costs of implementation activities at spoke sites. Implementation reach outcomes for the first 36 months of implementation were extracted from the electronic health record. Service utilization data was combined with cost data to calculate cost per patient reached and per clinical encounter achieved at each site.

RESULTS

Total facilitation costs (range: $1,746-$7,978) and unique patients reached (range: 2-46) varied considerably across spoke sites and greater staff implementation efforts (measured in time or cost) were not associated with greater numbers of patients reached. Therefore, costs per patient reached also varied widely (range: $120-2,569) across spoke sites. Key challenges included high rurality and small clinic size; insufficient engagement of frontline providers; lack of referral options for high acuity patients; and lack of existing programming within which to situate pain services.

CONCLUSIONS

At spoke sites where patients were consistently referred and reached, costs were relatively modest, particularly compared to the high cost of untreated chronic pain, suggesting the potential impact of this model at scale. However, in spoke sites where referrals and encounters were low during initial implementation, cost per patient was high. Findings highlight the need for better methods for tailoring of facilitation interventions to spoke site's individual needs to maximize impact.

Implementation and acceptability of the Caregiver Care Model in general practice: a mixed-method feasibility study

BACKGROUND

Being a caregiver can be demanding. Therefore, we developed the Caregiver Care Model for general practice. The model consists of a mandatory dialogue questionnaire, which is used to identify support needs in caregivers, grief-facilitating questions, and an overview of community-based caregiver initiatives for caregivers in need of support. We aimed to test the implementation and acceptability of the model in general practice.

METHODS

We used a fixed, convergent, mixed-methods approach to test the model in five general practices in the Central Denmark Region among 40 caregivers. Quantitative data included monitoring data collected by health professionals in an online database at inclusion and after each consultation. Qualitative data were derived from five introductory meetings and semi-structured interviews with ten health professionals. The analysis focused on the implementation (delivery and process) and the health professionals' acceptability of the model.

RESULTS

All 40 caregivers participated in the first consultation, and 29 (73%) had two or more consultations. Eight caregivers (20%) were referred to community-based initiatives or a private-practice psychologist. The mandatory dialogue questionnaire was completed by 30 (75%) caregivers prior to the first consultation, and it was rated useful by general practitioners (GPs) and staff in 26 (74%) of encounters. GPs and staff perceived the dialogue questionnaire to be useful to direct the first consultations towards the most relevant issues, whereas the usefulness of the facilitating questions was unclear due to the brief introduction to them. The list of community-based initiatives was considered useful in urban areas, but not in rural areas with long distance to initiatives. Here, support from general practice was needed to promote mental health in caregivers and avoid sick leave.

CONCLUSION

The Caregiver Care Model was in line with core values of general practice and the dialogue questionnaire targeted the consultations on relevant issues for the caregiver. Health professionals provided targeted support, including follow-up consultations and referred a group for community-based initiatives, especially caregivers in urban settings. The findings call for increased focus on caregivers and education of general practitioners and staff to facilitate caregiver reactions in connection with loss and grief.

Harnessing Implementation Science in Clinical Psychology: Past, Present, and Future

Implementation science aspires to equitably accelerate the uptake of clinical research into practice to improve population health. The focus of implementation science includes individual behavior change mechanisms that are similar to those that drive the field of clinical psychology. For this reason, clinical psychologists are well-suited to take up implementation science methods in pursuit of improving the quality of behavioral health care. To do so, clinical psychologists must expand beyond individual behavior change to include a focus on organizations and systems. In this review, we reflect on ways that clinical psychologists can lead in the integration of implementation science principles and approaches into clinical psychology research and practice. We discuss the role clinical psychologists play in closing know-do gaps in behavioral health and describe how clinical psychologists can build implementation science competencies. We end with current controversies and opportunities for innovation to further improve the quality of behavioral health care.

Integrating Implementation Outcomes into Effectiveness Studies: A Practical Guide for Clinical Interventionists

Designing effectiveness studies with implementation in mind can allow interventionists to translate their research into real-world practice. Implementation outcomes measure how much and how well a particular intervention was implemented and can provide valuable insights into any heterogeneity in effectiveness outcomes. As part of the National Institutes of Health's (NIH) Helping to End Addiction Long-term® (HEAL) Initiative's Data2Action program, a workgroup of the Research Adoption Support Center (RASC) was tasked with creating a resource guide to aid clinical interventionists in integrating implementation outcomes into their research plans. This paper aims to provide a plain-language, pragmatic guide to implementation outcomes for clinical interventionists, including key considerations for each outcome and examples of implementation-effectiveness studies that reported implementation outcomes. We conclude by discussing the limitations of our guide and implementation outcome reporting more broadly. We offer suggestions for implementation scientists and clinical interventionists to work toward a common goal of improved implementation outcome reporting.

Fidelity, not adaptation, is essential for implementation

Fidelity is not yet a requirement when developing an evidence-based innovation or when attempting to use an innovation in typical settings. Currently, users are encouraged to adapt innovations to fit existing practitioner skills and organization situations. Instead of adapting innovations, the essential components of an innovation need to be established in the original research and the essential components need to be used in practice with the support of implementation processes so that promised outcomes can be realized. Fidelity is an assessment of the presence and strength of the essential components that define the independent variable (the innovation) and is directly linked to outcomes. A test of any fidelity assessment is a high correlation (0.70+) with outcomes. The functional relationship between fidelity and outcomes ensures that the essential components are effective and ensures that a reliable fidelity assessment is available. Implementation is the planned process of putting something into effect. Evidence that an innovation has been put into effect is provided by the fidelity assessment. High fidelity scores indicate that the essential components of the innovation are in place and good outcomes are expected. A test of any planned process is fidelity of the use of the innovation. At present fidelity assessments are missing or inadequate and, therefore, there is a notable lack of evidence that an independent variable is present.

From glitter to gold: recommendations for effective dashboards from design through sustainment

BACKGROUND

Dashboards-tools that compile and summarize key performance data-have become increasingly utilized for supporting data organization and decision-making processes across various fields, such as business, economics, healthcare, and policy. The dashboard's impact is dependent on its use by the individuals for whom it was designed. Yet, few studies measure dashboard use, and of those that do, their utility is limited. When dashboards go unused, they provide little value and impact. We argue that successful and long-term use of dashboards can be achieved using human-centered design and implementation science methods.

MAIN BODY

In this article, we describe the characteristics of dashboards and provide examples of existing dashboards. We discuss the common pitfalls of dashboards that result in their limited use. Next, we proffer how human-centered design and implementation science can improve dashboard relevance. We provide eight recommendations from across the design to the sustainment phase. To guide dashboard developers and implementers, we organize our recommendations using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Lastly, we raise several cautions when using human-centered design and implementation science methods in dashboard development and implementation.

CONCLUSION

There is a need for more effective, sustainable, and impactful dashboards. We suggest that incorporating human-centered design and implementation science methods can facilitate achieving this goal.

Development of a generalised tool for evaluating success of clinical practice guidelines implementation (A-GIST)

OBJECTIVES

To develop a generalised tool to evaluate the success of implementation of clinical practice guidelines (CPGs).

DESIGN AND SETTING

Systematic review, group brainstorming discussion and modified Delphi method.

PARTICIPANTS

A steering group (3 members) was assembled responsible for the guidance and ensuring stakeholder's involvement. A tool development group (24 members) of leading experts provided expertise in refining the frame and items during the development and participated in the Delphi process. And a secretary group (7 members) was responsible for the organization and coordination, systematic reviewing, drafting of the preliminary list of items, documenting and revising the tool according to the suggestions of the development group.

INTERVENTIONS

Four process stages were employed. First, the project was launched with core groups formed for the development. Second, based on the Reach Effectiveness Adoption Implementation Maintenance framework, a systematic review of existing methods for evaluating the success of CPGs implementation and a brainstorming discussion were conducted to form a preliminary list. Third, a modified Delphi method was organised, integrating a multidisciplinary face-to-face consultation meeting with two rounds of online Delphi consultations. Fourth, the tool was revised and finalised incorporating all expert suggestions.

RESULTS

Development teams comprising multidisciplinary experts were formed. In the systematic review, 7 biomedical literature databases were searched, and 208 pieces of literature were included. After three rounds of brainstorming discussions on items identified in the literature, a 23-item preliminary list was produced. In the modified Delphi method, 14 experts made 23 main suggestions in the face-to-face meeting on the list. 13 experts participated in the first round of Delphi consultation, reached agreement on 20 items, removed 4 items and added 1 new item. 11 experts attended the second-round consultation and had an agreement to include 20 items after revision.

CONCLUSIONS

The Guideline Implementation Success Assessment Tool (A-GIST) was systematically developed as a comprehensive tool to assess the success of CPGs implementation. It comprises 5 dimensions, Reach, Adoption, Implementation, Effectiveness and Maintenance, encompassing 20 items that integrate perspectives from both clinicians and patients. A-GIST is designed to facilitate evaluating, benchmarking and cross-comparison of implementation success between guidelines, facilities and regions. Additionally, it provides evidence-based insights to inform the development of targeted strategies for optimising guideline implementation practices.

Cross-Sectional associations between inner setting determinants of self-efficacy and intent to deliver a healthy eating and activity curriculum embedded in a community setting

BACKGROUND

Healthy Eating and Active Living Taught at Home (HEALTH) embeds healthy eating and activity content within Parents as Teachers (PAT), a national home visiting program. HEALTH is evidence based to prevent weight gain among mothers of young children. This secondary analysis aims to understand the factors associated with intention and self-efficacy to deliver HEALTH among parent educators (home vising providers).

METHODS

This is a cross-sectional, secondary analysis of data from a trial evaluating the effectiveness of HEALTH when delivered by parent educators as part of usual practice. Parent educators completed surveys following training in the HEALTH intervention; demographic characteristics (including self-reported body mass index) were collected in a baseline survey (pre-training). Surveys were based on two implementation science frameworks: Consolidated Framework for Implementation Research (CFIR, implementation context) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM, implementation outcomes). Associations between intent to deliver HEALTH (intent) and self-efficacy (SE) to deliver HEALTH, implementation context constructs and demographic characteristics were explored using Pearson correlations (continuous variables) and t-tests (binary variable). Relationships were considered significant if the p-value was < 0.05.

RESULTS

Among the 149 parent educators who completed the survey, just over half identified as white/non-Hispanic (53%), while just over a third identified as Hispanic. Participants reported having worked at their site for a mean of 4.7 years (standard deviation, SD = 5.85), and the mean body mass index was 30.43 kg/m2 (SD = 7.35). There was a significant correlation between intent and SE, r = 0.46 (< 0.0001). Most demographic characteristics (e.g., body mass index, age) were not significantly correlated with either variable, however, intent and SE were both significantly lower among white non-Hispanic parent educators than among those identifying as another race/ethnicity. Several other implementation context constructs such as evidence strength and quality, mission alignment, appeal, openness, and relative advantage were positively correlated with both intent and SE; complexity was negatively correlated.

CONCLUSIONS

When implementing healthy eating and activity content within community settings, it is important to consider what factors may be related to provider intent and provider self-efficacy to deliver the content. Specifically, mission alignment, complexity, evidence strength and quality, and relative advantage may be important.

TRIAL REGISTRATION

NCT03758638 ( https://clinicaltrials.gov/study/NCT03758638 ), registered Nov 29, 2018.

Mechanisms of change of a multifaceted implementation strategy on fidelity to a guideline for the prevention of mental health problems at the workplace: A mechanism analysis within a cluster-randomized trial

Background

Occupational guidelines exist to support workplaces with the prevention of mental health problems (MHP) among their staff. However, knowledge of effective implementation strategies to support their implementation is limited. This study experimentally tested whether a multifaceted implementation strategy - comprising an educational meeting, five workshops, implementation teams, small cyclical tests of change, and facilitation - improves fidelity to a guideline for preventing MHP in a school setting through the pathway of change of the Capability Opportunity Motivation-Behavior (COM-B)-model. To gain a more granular understanding of the mechanisms of change, the Theoretical Domains Framework (TDF) was used to specify mediators related to capability, opportunity, and motivation. This study tested whether the multifaceted strategy versus a discrete strategy (1) improves fidelity, (2) enhances capability, opportunity, and motivation over time, and (3) if the strategy's effect on fidelity is mediated by capability, opportunity, and motivation.

Methods

55 schools were randomly assigned to a multifaceted strategy or a discrete strategy. Fidelity was measured by questionnaires at baseline and 12 months, while capability, opportunity, and motivation were assessed three times within this period (directly after the educational meeting and at three and nine months). The Determinants of Implementation Behavior Questionnaire was used to assess TDF hypothesized mediators corresponding to the COM-B components. Separate pathways were analyzed for each mediator. Linear Mixed Modeling was employed to test the strategy's effect on fidelity, and mediation analyses were conducted using the PROCESS Macro.

Results

The multifaceted strategy led to improved fidelity at 12 months (B= 2.81, p<.001). Multifaceted schools reported higher scores for all mediators after nine months compared to schools receiving the discrete strategy. The effect of the multifaceted strategy on fidelity was partially mediated by all TDF mediators (p=<.05) except for beliefs about consequences. Capability-related mediators, including skills (Proportion-mediated= 41%, p=<.01) and behavioral regulation (Proportion-mediated= 35%, p=<.001), accounted for the largest proportion of the effect, followed by the motivation-related mediator goals (Proportion-mediated = 34%, p=<.01).

Conclusions

The multifaceted strategy improved guideline fidelity by enhancing capability, opportunity, and motivation confirming the proposed function of COM-B. This study addresses calls for experimental evidence on how multifaceted implementation strategies achieve implementation outcomes.

Trial registration

ClinicalTrials.org dr.nr 2020-01214.

How do we leverage implementation science to support and accelerate uptake of clinical practice guidelines in transfusion medicine

BACKGROUND

Developing and disseminating clinical practice guidelines is a common strategy used to inform practice and address evidence-to-practice gaps that are prominent in transfusion medicine. Despite a highly systematic method for synthesizing evidence into guideline recommendations, comparatively little attention is paid to the real-world implementation of the recommendations in routine practice. A more scientific approach drawing on learnings from the field of implementation science is therefore warranted.

STUDY DESIGN AND METHODS

In this article, we propose a methodological roadmap to embed implementation science principles, frameworks, and methods to facilitate the development and uptake of transfusion medicine guidelines. We draw upon research undertaken in partnership with the International Collaboration of Transfusion Medicine Guidelines (ICTMG) to illustrate the roadmap in action.

RESULTS

The methodological roadmap constitutes five steps which have been matched to existing processes for developing and implementing clinical practice guidelines: (1) environmental scan; (2) detailing who needs to do what differently, per guideline recommendation; (3) barriers and enablers assessment; (4) tailoring implementation strategies to identified barriers and enablers; and (5) implementation and evaluation of implementation strategies. For each step, we define the key concepts and methods involved, and share examples from work done with ICTMG to support transfusion medicine guideline implementation.

DISCUSSION

We intend this methodological roadmap for clinicians, researchers, and organizations involved in supporting clinical practice guideline use. Informed by principles, frameworks, and methods from implementation science, the roadmap can provide a more structured, transparent, and replicable approach to improve the implementation of guideline recommendations in transfusion medicine.

Implementation science and entrepreneurship: Two complementary frameworks for advancing pharmacy practice

BACKGROUND

Academic leaders and clinicians have promoted implementation science (IS) and entrepreneurship (EN) as frameworks for transforming pharmacy education and practice. Although distinct, IS and EN share many of the same processes and goals in promoting solutions to problems in healthcare.

OBJECTIVES

To distinguish the similarities and differences between IS and EN. Major components of each method will be evaluated for relative strengths and limitations in advancing pharmacy practice interventions.

METHODS

Basic components of IS and EN were compared. The Consolidated Framework for Implementation Research Intervention (CFIR) was used to represent the elements of IS and the resource-based theory of competitive advantage was used to operationalize key constructs in entrepreneurship. The five CFIR domains matched well with the five constructs of the resource-based theory of competitive advantage, allowing five common components for comparisons: (1) intervention, (2) cost benefit, (3) market viability, (4) organizational setting, and (5) characteristics of the individuals and inputs.

RESULTS

IS and EN are two scholarly approaches that differ primarily in how they frame research questions. IS frameworks prioritize the study of the implementation of evidence-based interventions and their theoretical contributions. They focus predominantly on quantifying the impact of the intervention and less so on the needs of community partners, market viability of intervention, and return on investment. EN is more open to interventions that lack strong objective evidence for effectiveness, relying more on what makes an intervention financially sustainable and profitable in markets.

CONCLUSION

IS and EN both examine the role of the intervention, organization, market viability, inputs, and financial return on the successful adoption and sustainability of interventions. Either framework can be used to advance the adoption and dissemination of pharmacy practice interventions, as long as researchers understand the limitations of each framework.

User journey method: a case study for improving digital intervention use measurement

BACKGROUND

Many digital mental health interventions meet low levels of use. However, current use measurement methods do not necessarily help identify which intervention elements are associated with dropout, despite this information potentially facilitating iterative intervention development. Here, we suggest improving the comprehensiveness of intervention use measurement with the user journey method, which evaluates every intervention element to identify intervention-specific use barriers.

METHODS

We applied user journey method in a clinical trial that investigated the efficacy of a novel game-based intervention, Meliora, for adult Major Depressive Disorder. We modelled the intervention for its four technological (Recruitment, Website, Questionnaires, Intervention Software) and two interpersonal elements (Assessment, Support). We then applied the user journey method to measure how many users proceeded from one element to the next combining social media analytics, website use data, signup data, clinical subject coordinator interview data, symptom questionnaire data, and behavioral intervention use data. These measurements were complemented with the qualitative analysis of the study discovery sources and email support contacts.

RESULTS

Recruitment: The intervention recruitment reached at least 145,000 Finns, with social media, word-of-mouth, and news and web sources being the most effective recruitment channels. Website: The study website received 16,243 visitors, which led to 1,007 sign-ups.

ASSESSMENT

895 participants were assessed and 735 were accepted. Intervention Software: 498 participants were assigned to the active intervention or comparator, of whom 457 used them at least once: on average, for 17.3 h (SD = 20.4 h) on 19.7 days (SD = 20.7 d) over a period of 38.9 days (SD = 31.2 d). The 28 intervention levels were associated with an average dropout rate of 2.6%, with two sections exhibiting an increase against this baseline. 150 participants met the minimum adherence goal of 24 h use. Questionnaires: 116 participants completed the post-intervention questionnaire.

SUPPORT

313 signed-up participants contacted the researchers via email.

CONCLUSION

The user journey method allowed for the comprehensive evaluation of the six intervention elements, and enabled identifying use barriers expediting iterative intervention development and implementation.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05426265. Registered 28 June 2022, https://clinicaltrials.gov/ct2/show/NCT05426265 .

Dissemination and Implementation-A Primer for Accelerating "Time to Translation" in Radiation Oncology

The field of radiation oncology has achieved significant technological and scientific advancements in the 21st century. Yet uptake of new evidence-based practices has been heterogeneous, even in the presence of national and international guidelines. Addressing barriers to practice change requires a deliberate focus on developing and testing strategies tailored to improving care delivery and quality, especially for vulnerable patient populations. Implementation science provides a systematic approach to developing and testing strategies, though applications in radiation oncology remain limited. In this critical review, we aim to (1) assess the time from first evidence to widespread adoption, or "time to translation," across multiple evidence-based practices involving radiation therapy, and (2) provide a primer on the application of implementation science to radiation oncology. Specifically, we discuss potential targets for implementation research in radiation oncology, including both evidence-based practices and quality metrics, and highlight examples of studies evaluating implementation strategies. We also define key concepts and frameworks in the field of implementation science, review common study designs, including hybrid trials and cluster randomization, and discuss the interaction with related disciplines such as quality improvement and behavioral economics. Ultimately, this review aims to illustrate how a comprehensive understanding of implementation science could be used to promote equity and quality in cancer care through the development of effective, scalable, and sustainable care delivery solutions.

Leveraging implementation science to solve the big problems: a scoping review of health system preparations for the effects of pandemics and climate change

As the planet warms and pandemics become more common, health systems will face disruptions to both their service delivery and their workforce. To minimise the severity of these impacts, health systems will need to efficiently and rapidly prepare, adapt, and respond. Implementation science will be crucial to the success of these actions. However, the extent to which health systems are using implementation science to address the pressures of pandemics and climate change is not currently known. In this scoping review, we aimed to address this research gap. We reviewed empirical studies that used implementation science to adapt, respond to, or prepare a health-care setting for a pandemic or climate-related event, defining components of implementation science (as proposed by Nilsen [2015]) and implementation evaluation outcomes (as proposed by Proctor and colleagues [2011]). We found a growing evidence base describing the use of implementation science in health system responses to pandemics (n=54 studies), but a dearth of similar evidence for climate change (n=2 studies). Future research could benefit from applying the principles of implementation science in pre-implementation phases and purposefully planning for long-term, ongoing evaluations, which will facilitate tailored and sustainable health system responses to climate-related and pandemic events.

Human-Centered Design to Enhance Implementation and Impact in Health

Human-centered design (HCD) is an approach that aligns innovation development with the needs of the people and the settings where those innovations will be used. HCD is increasingly being applied across a variety of health domains, most often with the goals of translating research into real-world settings and expanding innovation adoption. This review introduces key HCD concepts, reviews the growth of HCD in public health and its alignment with the complementary field of implementation science, and details four prominent proximal outcomes of design processes: (a) usability, (b) user burden, (c) contextual appropriateness, and (d) engagement. For each outcome, we provide a definition and background, measurement options, and critiques and future directions. We conclude with a series of opportunities and challenges, including an inclusive big tent spanning different design traditions, pathways for enhancing HCD's scientific legitimacy, and explicit promotion of equitable design processes to improve individual, community, and population health.

Implementation strategies used in policy, systems, and environmental interventions addressing obesity-related outcomes in early childhood education settings: a systematic review

BACKGROUND

Policy, systems, and environmental (PSE) approaches, including those enacted in early childhood education (ECE) settings, can improve child health outcomes. The use of implementation strategies, or the ways in which these approaches are enacted across settings, may modify intervention impact. Therefore, the purpose of this review was to examine the implementation strategies used among interventions utilizing PSE approaches in the ECE setting.

METHODS

Seven databases including MEDLINE, PubMed, Web of Science, and EMBASE, were searched for interventions in ECE settings including children (0-6 years) that utilized ≥ 1 PSE approach. Eligible studies included either a child-level outcome (i.e., weight, physical activity, or diet) or an environmental outcome (i.e., nutrition and physical activity environment). Data extracted included study characteristics, description of the intervention, and description of the implementation of the intervention. Implementation strategies were coded using the School Implementation Strategies Translating ERIC Resources (SISTER) taxonomy. The Downs and Black checklist was completed to assess study quality.

RESULTS

One hundred and four studies representing 97 interventions were identified. Fourteen (14%) did not report any implementation strategies. Of the remaining 83 interventions reporting implementation strategies, the mean number of implementation strategies employed per intervention was 3.8 (± 2.3) (range 1-11). However, few interventions (5/83, 6%) clearly named and defined implementation strategies. Most implementation strategies came from the "train and educate stakeholders" SISTER domain (177/318, 56%), and the most frequently used implementation strategy was "conduct educational meetings (50/83, 60%). Most studies were classified as good (59/104, 57%) or fair (40/104, 38%) quality.

CONCLUSIONS

In this review, many interventions appeared to use multiple implementation strategies to support ECE PSE interventions, though few explicitly documented or described those strategies. These findings suggest that more precise documentation of implementation strategies is needed to enhance replication and scalability of ECE interventions.

REGISTRATION

PROSPERO# CRD42022306670.

Evaluating the implementation of adult smoking cessation programs in community settings: a scoping review

Introduction

Tobacco smoking is a leading contributor to preventable morbidity and premature mortality globally. Although evidence-based smoking cessation programs have been implemented, there is limited evidence on the application of theories, models, and frameworks (TMFs), and implementation strategies to support such programs. This scoping review mapped the evidence for interventions, TMFs, and implementation strategies used for smoking cessation programs in the community.

Methods

We searched four electronic databases in addition to grey literature and conducted hand-searching between February and December 2023. Original studies of qualitative, quantitative, or mixed methods were considered for inclusion. Studies reporting prospectively planned and/or delivered implementation of smoking cessation interventions or programs, incorporating contextual factors, use of implementation TMF, implementation strategies, or other factors influencing implementation were considered for inclusion. Intervention components were categorized using the Template for Intervention Description and Replication (TIDieR) checklist. Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC) Strategy Clusters.

Results

A total of 31 studies were included. We identified 12 discrete interventions, commonly included as part of multicomponent interventions. Most studies reported tailoring or modifying interventions at the population or individual level. We identified 19 distinct implementation TMFs used to prospectively guide or evaluate implementation in 26 out of 31 included studies. Studies reported diverse implementation strategies. Three studies embedded culturally appropriate TMFs or local cultural guidance into the implementation process. These studies took a collaborative approach with the communities through partnership, participation, cultural tailoring, and community-directed implementation.

Discussion

Our findings highlight the methods by which the implementation of smoking cessation may be supported within the community. Whilst there is debate surrounding their necessity, there are practical benefits to applying TMFs for implementing, evaluating, and disseminating findings. We determined that whilst ERIC was well-suited as a framework for guiding the implementation of future smoking cessation programs, there was inconsistent use of implementation strategies across the ERIC domains. Our findings highlight a lack of harmonization in the literature to culturally tailor implementation processes for local communities.

Bridging the gap: translating and simplifying CFIR 2.0 for French practitioners in implementation science

BACKGROUND

The Consolidated Framework for Implementation Research (CFIR) 2.0 is widely used in implementation projects but can be difficult for non-researchers to apply due to its complexity. While a French version of the original CFIR exists, CFIR 2.0 had not yet been translated. This study aimed to translate and simplify CFIR 2.0 for healthcare practitioners in French-speaking Switzerland to improve its accessibility and utility.

METHOD

Using the Principles of Good Practice for Translation and Cultural Adaptation, the process included: (1) four independent forward translations, (2) reconciliation of simplified definitions, (3) online survey with 16 clinical nurse specialists to assess the content validity of the simplified definitions, (4) back translation, and (5) harmonization to finalize the French version. The content validity of each construct was assessed using the Content Validity Index (CVI), with further revisions based on feedback.

RESULTS

Most participants found the simplified definitions understandable, with an average score of 1.46 (where 1 is "very easy to understand" and 2 is "easy to understand"). Thirteen items with lower I-CVI scores (≤ 0.78) were revised. The overall S-CVI was 0.87, indicating high content validity. Minor discrepancies in the back translation were resolved.

CONCLUSIONS

This study produced a French translation of CFIR 2.0 with simplified definitions tailored for healthcare practitioners. The high content validity and feedback underscore the need for contextually relevant adaptations to enhance the practical use of the CFIR framework. Further testing in diverse French-speaking contexts is necessary to refine the tool and broaden its applicability in real-world settings.

How theories, models, and frameworks have been used to implement digital health interventions in services for people with severe mental health problems: a scoping review

BACKGROUND

Digital health interventions have the potential to improve the efficacy and accessibility of mental health services for people with severe mental health problems, but their integration into routine practice is a challenge. The real-world implementation of digital health interventions should be considered alongside digital intervention development. However, little is known about the quality of implementation research in this area, including the extent to which implementation science theories, models and frameworks are used. The aim of this review was to synthesise evidence regarding the application of theories, models and frameworks in research investigating the implementation of digital health interventions in services for people with severe mental health problems. Secondary aims were to consider the contexts within which studies had been undertaken and the degree of service user involvement in this research.

METHODS

A scoping review method was employed. Electronic databases were systematically searched for published papers in English and reference lists of included studies were hand searched. Included studies used an implementation science theory, model, or framework to understand, guide or evaluate the implementation of digital health interventions in services for people with severe mental health problems.

RESULTS

Twelve eligible studies were identified. Studies were primarily undertaken in community mental health services with staff participants and there was variation in the types of digital interventions that were investigated. Eight different implementation science theories, models, and frameworks were used and were mainly employed to guide qualitative analysis. Most studies were undertaken in the early exploratory stages of implementation projects and there was little evidence regarding factors affecting the longer-term sustainment of digital health interventions in practice. Only one study reported the inclusion of service users in the design of the implementation study.

CONCLUSIONS

The use of implementation theories, models, and frameworks in efforts to implement digital health interventions in routine care for people with severe mental health problems is limited. Researchers should consider integrating such approaches throughout the research process and ensure service users are involved in this work. Further research regarding implementation processes, and the reach and sustainment of digital health interventions in routine practice, is required.

The wide-angle lens of implementation science to improve health outcomes in criminal legal settings

BACKGROUND

Implementation science (IS) is an emerging discipline that offers frameworks, theories, measures, and interventions to understand both the effective organizational change processes and the contextual factors that affect how well an innovation operates in real-world settings.

RESULTS

In this article, we present an overview of the basic concepts and methods of IS. We then present six studies where IS was used as a means to understand implementation of a new innovations designed to improve the health and well-being of individuals under criminal legal system supervision.

CONCLUSION

We discuss how IS has developed new knowledge on how to implement efficacious innovations and suggesting future research needed to further our understanding of implementation and sustainability of innovations in the legal context.

Screening for comprehensive social needs in patients with cancer: a narrative review

BACKGROUND

Patients with cancer who report social needs have worse quality of life, lower health-care access, and suboptimal health outcomes. However, screening for social needs does not happen systematically, and successful screening tools, strategies, and workflows have seldom been described. The downstream effects of screening including resource navigation have also not been well characterized. The objective of this narrative review was to fill these gaps.

METHODS

Two investigators searched PubMed and Embase for studies that implemented a patient-facing social screening tool among patients with cancer between 2008 and 2023 using search terms including social screening, social  needs, and cancer.

RESULTS

We identified 19 articles that met study inclusion criteria. The most common tool used was the validated Health Leads Social Toolkit. Most often, screening tools were administered electronically, sent directly to patients, and captured needs at a single time point during a patient's diagnosis. Screening response rates ranged between 10% and 60%. Less than half of the studies described downstream resource navigation for patients who screened positive for social needs. Only 1 study evaluated the impact of screening on clinical outcomes and quality of life. Screening for patients who do not speak English or who belong to historically racial, ethnic, and gender minority groups was limited.

CONCLUSIONS

Screening for social needs has been shown to be feasible across delivery systems with numerous validated tools available. However, gaps remain in generalizability to diverse patient populations. Future work must identify how screening workflows can be successfully incorporated into routine clinical workflows.

Description of implementing a mail-based overdose education and naloxone distribution program in community supervision settings during COVID-19

INTRODUCTION

This study uses the Exploration, Preparation, Implementation, and Sustainment (EPIS) model to retrospectively describe the mail-based overdose education and naloxone distribution (OEND) program developed in collaboration with the Kentucky Department of Corrections (DOC) for use in the HEALing Communities Study in Kentucky (HCS-KY) and details the reach of this innovative delivery model.

METHODS

HCS-KY is a community-engaged cluster-randomized trial assessing the effects of implementing evidence-based practices, including OEND, on overdose death reduction across 16 communities highly impacted by the opioid epidemic in Kentucky.6 The study launch coincided with the COVID-19 pandemic. All coalitions in the 16 HCS-KY counties selected OEND implementation in community supervision offices; however, pandemic limitations on in-person reporting made face-to-face OEND unfeasible. This study uses the EPIS phases to understand how the unique inner and outer contextual factors of the pandemic drove innovation, including five implementation strategies to promote the mail-based OEND program. Internal study management trackers data measured implementation reach.

RESULTS

Implementation occurred in all 16 counties. All promotional strategies used in the first 8 counties (Wave 1) were carried over to the second 8 counties (Wave 2), except letters were not sent to community supervision clients in Wave 2 counties. Across both waves, 1759 people accessed the Typeform™ website to receive overdose education, complete a brief demographic survey, and 1696 had naloxone shipped to their homes. Greater reach occurred in Wave 1 and in rural counties. Of the participants, 81.13 % were white, 61.17 % were female, 51.79 % were between the ages of 35-54, 18.82 % had previously experienced an overdose, and 69.07 % had witnessed an overdose. Sites sustained three of the five implementation strategies for publicizing the OEND website at the study's end but not letters and texting.

CONCLUSIONS

Mail-based OEND programs are an appropriate delivery method for ensuring access to life-saving medication for people on community supervision and may encourage treatment. Strategies to promote the OEND program that were high-effort for agency and study staff, such as letters, or high-cost, such as texting, were not sustainable. Implications for OEND best practices, including innovative technology use within community supervision settings are addressed.

Implementing the Eat, Sleep, Console Model of Care: A Scoping Review

OBJECTIVE

The Eat, Sleep, Console (ESC) model of care is an innovative care approach for infants diagnosed with neonatal abstinence syndrome, improving patient and health system outcomes for this equity-deserving population. Little is known about sustainably implementing this model into practice. The objective is to map evidence on implementing the ESC model into clinical practice, including strategies, barriers and facilitators to implementation, and evaluation outcomes.

METHODS

Data sources include MEDLINE, Embase, CINAHL, PsycINFO, Google Scholar, and websites identified by a Google search. The study selection included articles exploring the implementation or evaluation of the ESC model in clinical practice since its 2017 conception. Two reviewers independently screened each study using a predetermined screening tool. Data were extracted by 2 independent reviewers from included articles.

RESULTS

The review identified 34 studies. Barriers to implementing the ESC model include resource limitations and systemic oppression and bias. Facilitators include health care provider education and empowerment of parent engagement. The most reported cluster of strategies (31.6%) included training and educating stakeholders. Gaps were noted in the exploration of implementation outcomes/processes, and equity implications on implementation.

CONCLUSIONS

The ESC model of care has been successfully implemented in various settings with positive patient and health system outcomes, including decreased hospital stay and pharmacological treatment of infants. However, there is a gap in exploring implementation processes and outcomes. Future research should explore the contextual elements of the implementation by equitably examining implementation outcomes specific to the ESC model of care.

Examining implementation outcomes in health information exchange systems: A scoping review

BACKGROUND

Health information exchange (HIE) facilitates the secure exchange of digital health data across disparate health systems and settings. The implementation of information technology projects in healthcare is complex, further complicated by the fact that implementation success, through the measure of implementation outcomes, has been inconsistently defined and evaluated. There is no known scoping review examining implementation success through implementation outcomes in the field of HIE technologies. The aim of this scoping review was to provide a synthesis of studies related to reported implementation outcomes of HIE solutions (and related interoperability technologies) with a goal to inform the implementation of large-scale HIE projects in the future.

METHODS

A scoping review, guided by the Arksey and O'Malley Framework, was conducted in four databases (Medline, Embase, CINAHL, and Web of Science), gathering studies from January 2010 to June 2023. Studies that described the implementation of a technology supporting interoperability or HIE across different organizations and/or across different healthcare settings and described the evaluation of one or more implementation outcomes from the Implementation Outcome Framework (IOF) were included.

RESULTS

37 studies were included in this review. The implementation outcome adoption was most frequently reported (n = 24). Fidelity and penetration were not reported. Few studies provided definitions for the outcomes being evaluated. Few studies provided details surrounding the stage of implementation as it relates to the outcome examined. No studies used the IOF or other similar implementation science evaluation frameworks.

CONCLUSION

This review highlights the existing gaps in the field of HIE/interoperability solutions implementation studies. Future studies should employ theoretical frameworks to guide their research, standardize language used to describe implementation outcomes, and expand knowledge of salient outcomes at varying stages of implementation.

Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia

Background: A Mediterranean-style dietary pattern (MDP) is embedded across coronary heart disease (CHD) and type 2 diabetes (T2D) clinical guidelines. However, MDP evidence has not consistently been translated into practice. This study aimed to develop, integrate and evaluate implementation strategies to support clinicians in translating MDP evidence into routine care for CHD and T2D in the local context of a public health service. Methods: This study documents the implementation and evaluation phases of a broader knowledge translation project guided by the Knowledge-to-Action cycle. Multi-disciplinary clinicians in the cardiology and diabetes services of two large metropolitan hospitals and a post-acute community service were targeted. Strategies were prioritised utilising theory and stakeholder engagement and included facilitation, building a coalition, the engagement of clinical champions and local opinion leaders, educational meetings, consensus discussions, sharing local knowledge, consumer consultation, and the development and distribution of education materials. Surveys were conducted with clinicians and patients of targeted services to evaluate the reach, acceptability, feasibility, adoption and perceived sustainability of MDP in practice. Results: In total, 57 clinicians (7 dietitians, 29 nurses/diabetes educators, 15 doctors and 6 other allied health professionals) and 55 patients completed post-implementation evaluation surveys. The majority of clinicians agreed an MDP is appropriate to recommend in their clinical setting (95%), and most of the time/always their advice (85%) aligns. Education sessions were attended by 65% of clinicians, of which the majority indicated improved knowledge (100%) and change in practice (86%). Factors deemed most important to maintaining an MDP approach in practice were hard-copy education materials (85%) and access to a dietitian (62%). Of the patients who had received care from a dietitian of targeted services (n = 32, 58%), 100% recalled having discussed ≥1 MDP topic and 89% received education material. Of the patients who had received dietary advice from non-dietetic clinicians (n = 33, 60%), 67% recalled having discussed ≥1 MDP topic and 70% received education material. Conclusions: Targeted and theory-informed implementation reached the majority of surveyed clinicians and patients, and positively influenced the adoption, acceptability and feasibility of an MDP approach in routine care. Ongoing sustainability strategies are crucial with rotating clinician roles.

Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

BACKGROUND

Implementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners' outcome preferences influence their decisions in real-world scenarios.

METHODS

This study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.

RESULTS

All five outcomes significantly influenced practitioners' choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).

CONCLUSIONS

This study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners' holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs' adoption, sustainability, and impact.

Implementing TeamMAPPS: Formative qualitative findings from the dissemination and implementation study of a new evidence-based team science intervention

Introduction

Team Methods to Advance Processes and Performance in Science (TeamMAPPS) is an evidence-based Team Science competency model and intervention. TeamMAPPS was developed by experts in the Science of Team Science with translational teams in mind. TeamMAPPS focuses on three core teamwork competencies: (1) psychological safety, (2) awareness and exchange, and (3) self-correction and adaptation. In 2023, the TeamMAPPS framework was operationalized into five online training modules that can be used to train whole teams or individuals, with or without facilitation, in any order. This article reports formative findings from the pre-implementation stage of the TeamMAPPS Dissemination and Implementation (D&I) study.

Methods

We conducted 27 interviews and participant-observation fieldwork with 23 individuals involved in the conceptualization, design, or implementation of TeamMAPPS (four were interviewed twice). All implementers were affiliated with a Clinical and Translational Science Award (CTSA) hub. Data were collected during pre-implementation, when modules were being tested and early-stage implementers were being trained. We used D&I theories and frameworks to structure the study, analyze interview data, and recommend implementation strategies.

Findings

"Adoption," "reach," and "effectiveness" emerged as key implementation outcomes. TeamMAPPS was perceived to be evidence-based, highly adaptable, and a Team Science intervention offering unique benefits. We draw on participants' responses and expert recommendations to suggest implementation strategies.

Conclusions

CTSAs and other organizations can use varied strategies to implement TeamMAPPS. The flexibility of the intervention and its rootedness in an evidence-base synthesized by Team Science leaders make TeamMAPPS appealing for CTSAs seeking to enhance their team training offerings.

Implementation of medications for opioid use disorder in U.S. emergency departments: A systematic review

INTRODUCTION

Patients with opioid use disorder (OUD) experiencing withdrawal or nonfatal overdose often present to emergency departments (EDs). While professional societies endorse the initiation of evidence-based medications for OUD (MOUD) in the ED, low uptake persists. The purpose of this systematic review is to synthesize what is known about implementation of MOUD in EDs and to identify potential strategies to improve the uptake of MOUD in the ED.

METHODS

We reviewed articles that examined implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability, and cost) of MOUD in United States EDs. Peer-reviewed studies that used quantitative, qualitative, or mixed methods approaches were eligible for inclusion.

RESULTS

Twenty-seven articles met the inclusion criteria for one or more implementation outcomes. Forty-four percent (n = 11) reported on acceptability, 78 % (n = 21) reported on adoption, 26 % (n = 7) reported on appropriateness, and 15 % (n = 4) reported on feasibility. Eleven percent (n = 3) reported on fidelity, 7 % (n = 2) reported on penetration, and 7 % (n = 2) reported on sustainability. No articles reported on implementation cost. While physicians found MOUD acceptable, their comfort levels with the intervention varied. Rates of MOUD adoption were often low, but uptake may be facilitated by implementation strategies. MOUD may constrain ED time resources and exacerbate overcrowding, hindering appropriateness.

CONCLUSION

Results suggest that ED physicians and administrators have encountered barriers to the initiation of MOUD. There may be opportunities to overcome these implementation barriers using multi-component strategies consisting of educational interventions that address safety and monitoring and process interventions, such as clinical decision support systems.

Advancing Care Team Adoption of Electronic Health Record Systems for Cancer Symptom Management: Findings From a Hybrid Type II, Cluster-Randomized, Stepped-Wedge Trial

PURPOSE

The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors.

METHODS

Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months.

RESULTS

Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems v tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months.

CONCLUSION

EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.

Implementation of rural provider-to-provider telehealth in country Western Australia: a retrospective observational analysis via the RE-AIM framework

BACKGROUND

Rural provider-to-provider telehealth is growing globally. It is used to both facilitate equitable access to specialist healthcare services for those living in rural and remote areas and provide support to place-based providers. There is limited research on the implementation of these services, especially in an emergency or inpatient hospital setting. The Western Australia Country Health Service (WACHS) Command Centre is one such example. First implemented in 2012, the Command Centre services a geographical area covering 2.55 million square kilometres, a population of approximately 550,000, and provides five clinical streams including Emergency, Mental Health Emergency, Midwifery and Obstetrics Emergency, Inpatient, and Palliative Care Afterhours Telehealth Services.

OBJECTIVES

This study aimed to evaluate the implementation and access of rural provider-to-provider telehealth in country Western Australia, for the years 2012 to 2023.

METHODS

A retrospective observational analysis was conducted of all patient contacts managed by clinical telehealth streams of the Command Centre, between 31 August 2012 and 31 December 2023. Utilising descriptive statistics, analyses was informed by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework and Implementation Outcomes Framework (IOF) definitions.

RESULTS

Over the near 12-year period, a total of 215,965 service contacts were analysed from the five Command Centre clinical streams. There was large variation in the reach and adoption of services across regions, sites, and health facility types, however service scope and activity has increased steadily over time (maintenance). 95 of the 103 WACHS-managed sites had utilised Command Centre clinical telehealth services. The Command Centre has seen an increase in the proportion of clinical telehealth services provided to the most disadvantaged populations, demonstrating improved equity of access (effectiveness) over time.

CONCLUSION

There is a steady expansion in the availability of provider-to-provider clinical telehealth services delivered by the WACHS Command Centre across country WA, but with wide variability of usage depending on region, site, and health facility type. The results of this study show there is a need to understand the contextual factors influencing the adoption, implementation, and sustainability of the service.

Implementing psychosocial interventions for teachers' mental health: Protocol for integrating scoping review with teachers lived experiences in LMICs

INTRODUCTION

Teachers are pivotal in shaping educational environments and student development but face significant occupational stress and high rates of mental problems. Despite the availability of various psychosocial interventions, comprehensive evidence of their effectiveness and implementation is limited for this occupational group, especially in low- and middle-income countries (LMICs). This mixed methods study aims to conduct a scoping review of characteristics, effectiveness, and implementation outcomes of psychosocial interventions for teachers' mental health and mental problems, integrating these with teachers' lived experiences to inform the implementation of mental health interventions in LMICs.

METHODS

The study combines a scoping review with insights from an advisory group of teaching professionals with relevant lived experiences (PWLEs). The review will focus on examining psychosocial interventions studies promoting mental health or addressing mental problems among grade 1-12 school teachers of all genders, ages and contexts, except those working in specialized settings, such as special education centers, or disaster- or crisis-stricken zones. Intervention studies exclusively focusing on physical health or job-related outcomes will be excluded. Using pre-defined search terms, quantitative and qualitative research studies, including unpublished literature, will be searched across multiple databases. Titles and abstracts of identified studies will be screened against inclusion criteria, and the potentially relevant sources will be retrieved in full. Data will be extracted using a data extraction sheet developed for the study covering variables related to participant characteristics, intervention characteristics, study context, effectiveness and implementation outcomes. A purposively selected sample of 10 PWLEs will form the study advisory group and participate in four online workshop-group discussions. The meetings will include a presentation of the scoping review findings, followed by discussions on the relevance of these intervention packages for LMICs, adaptations needed to make them acceptable among school teachers and feasible for delivery in low-resourced settings like India. The synthesis of the data will employ narrative and thematic approaches to generate actionable insights for implementing psychosocial interventions in LMICs.

DISCUSSION

This study will provide comprehensive evidence on the characteristics and outcomes of psychosocial interventions for teachers' mental health and mental problems. By integrating insights from teachers with relevant lived experiences, the study will provide practical guidelines for adapting and implementing psychosocial interventions among school teachers in LMICs.

TRIAL REGISTRATION

Review registration number: Open Science Framework, doi.org/10.17605/OSF.IO/GF59J.

Mapping the landscape and evidence of cross-sectoral collaboration models targeting individuals referred for assessment of attention-deficit hyperactivity disorder or autism spectrum disorder: protocol for a scoping review

INTRODUCTION

Neurodevelopmental disorders, notably attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), present substantial challenges in mental health. Individuals referred for assessment in a psychiatric unit experience complex needs. This implies that their needs necessitate coordination across multiple sectors. Cross-sectoral collaboration models have emerged as essential strategies for addressing the complexities of these disorders. However, evidence of their existence, implementation and success remains limited. This protocol aims to outline a scoping review where we will explore existing collaboration models, evaluate their implementation and gain an understanding of how cross-sectoral collaboration models can be developed to ultimately benefit individuals referred for assessment of ADHD or ASD.

METHODS AND ANALYSIS

This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across PubMed, CINAHL, Embase, PsycINFO and Google Scholar, as well as grey literature sources, between 1 December 2024 and 1 January 2025. Inclusion criteria will encompass studies focusing on cross-sectoral collaboration for individuals referred for assessment of ADHD or ASD, published in English, Danish, Norwegian or Swedish. The search will use a three-block search string, with iterative refinement guided by familiarity with the evidence base. Data extraction will involve study characteristics and implementation details, using the Consolidated Framework for Implementation Research in combination with Proctor et al's implementation outcomes framework. Results will be synthesised into descriptive tables, providing a comprehensive mapping of existing models and emphasising implementation feasibility.

ETHICS AND DISSEMINATION

Ethical approval is not required for this protocol since it involves the review of existing literature without the involvement of human participants or personal data. Findings will be disseminated at national and international conferences and will be integrated into future efforts to develop cross-sectoral collaboration models in Denmark.

A qualitative study assessing acceptability and appropriateness of a technology-assisted mental health intervention by community frontline workers: mPareshan implementation research in rural Pakistan

BACKGROUND

With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-resource areas. This study examines the acceptability, appropriateness, barriers, and facilitators to implementing a technology-assisted mental health intervention (mPareshan) delivered by Lady Health Workers (LHWs) in rural Pakistan.

METHODS

This is a qualitative study embedded within a larger implementation research trial assessing the feasibility of an mHealth intervention aimed at improving anxiety and depression. 8 focus group discussions and 18 in-depth interviews were conducted. Perceptions were sought before and after intervention from stakeholders comprising of policymakers, LHWs, Lady Health Supervisors (LHSs), and community participants. Data underwent thematic analysis using the RE-AIM framework.

RESULTS

Six main themes emerged from the data. All participants had realization of rising burden of mental illnesses and identified key determinants for mental ill-health. Delivery of mental health counselling by LHWs through a technology-assisted intervention was deemed acceptable and appropriate. LHWs were considered capable and trustworthy by the community to deliver a home-based mHealth intervention, given their easy accessibility as residents of the same community. The technology demonstrated potential for easy adoption as these frontline health workers were already familiar with smartphone technology. Some barriers identified during implementation roll-out included heavy workload of LHWs and difficulty in internet connectivity. Use of videos for counselling, and supportive supervision by LHSs emerged as key facilitators for implementation.

CONCLUSION

This study highlights that a technology-focused mental health intervention is feasible, acceptable, and appropriate to be implemented by community frontline workers in resource-constrained rural Pakistani settings. The mPareshan intervention can be easily adopted within the LHW-P. Further research should investigate how implementation barriers can be addressed for successful delivery.

Implementation fidelity of a multisite maternity waiting homes programme in rural Zambia: application of the conceptual framework for implementation fidelity to a complex, hybrid-design study

Background

Implementation fidelity measures are critical for understanding complex interventions. Though maternity waiting homes (MWHs) are recommended by the WHO and have been used to help pregnant women access health facilities for decades, a gap exists regarding fidelity studies on MWHs. To better understand intervention outcomes results, we assessed the fidelity of implementation of an improved Core MWH Model in 10 facilities in rural Zambia.

Methods

We analysed indicators for fidelity employing a widely used conceptual framework. We compared performance from October 2016 to July 2018 to goals set out during intervention design. The Core MWH Model consists of three pillars-infrastructure, policies and linkages to care-each designed to be culturally appropriate and responsive to community standards for safety and comfort.

Results

70% of sites exhibited high adherence to the Core MWH Model components. User experience corroborated poorer performing elements: insufficient lighting, small cooking spaces, non-locking cabinets and few educational classes. Mission statements and governing documents were not always visible or available. The proportion of 3206 users who came from>10 km away was higher than the proportion of the surrounding population living at that distance except in two sites with low populations of remote-living women. Women stayed for just below the target of 14 nights. MWH occupancy rate overall was lower (52%) than the target (80%). MWH users reported high quality and satisfaction. Only three MWHs reached 50% female membership on their governance committees but met other key indicators for community ownership and engagement.

Conclusions

This fidelity evaluation of an MWH model in rural Zambia helps bridge the evidence-practice gap for the WHO's recommendation on implementing MWHs and adds to the expanding body of literature on implementation fidelity studies in global health.

Trial registration number

NCT02620436.

The inclusion of implementation outcomes in digital health interventions for young adults: A scoping review

Objective

Implementation outcomes are important in intervention research as a necessary precursor to achieving desired health outcomes. Considering the critical role of implementation outcomes, this study involved a comprehensive review of implementation outcome measures used in digital health interventions specifically targeting young adults.

Methods

This scoping review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, and the search incorporated the elements of population, concept, and content framework in three electronic databases (PubMed, Embase, and CINAHL). A matrix was used for data extraction and integrative thematic synthesis for analysis. Implementation outcomes were reported based on the indicators in each study, totaling eight outcomes: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability.

Results

The search yielded 2441 articles, and 17 were finally identified. The intervention implementation techniques that were adopted were telephone calls (n = 1); social media (n = 2); web-based programs (n = 4); short message service (n = 5); wearable devices (n = 1); mobile applications (n = 3); and a combination of phone calls, emails, and text messaging (n = 1). The highest number of implementation outcomes that were assessed in all the studies were acceptability (n = 10), feasibility (n = 10), and fidelity (n = 8). Short message service (n = 14), web-based programs (n = 11), and mobile applications (n = 7) had the highest number of implementation outcomes.

Conclusions

Researchers have largely assessed the acceptability and feasibility outcomes. The need to integrate the implementation outcomes framework in intervention research design is underscored.

Real-World Adoption of Mental Health Support Among Adolescents: Cross-Sectional Analysis of the California Health Interview Survey

OBJECTIVE

We aim to examine: (a) the extent to which patterns of adoption of counseling services and digital mental health interventions (DMHIs) shifted in recent years (2019-2021); (b) the impact of distress on adoption of mental health support; and (c) reasons related to adolescents' low adoption of DMHIs when experiencing distress.

METHODS

Data were from three cohorts of adolescents aged 12-17 years (n = 847 in 2019; n = 1,365 in 2020; n = 1,169 in 2021) recruited as part of the California Health Interview Survey. We estimated logistic regression models to examine the likelihood of using mental health support as a function of psychological distress, sociodemographic characteristics, and cohorts. We also analyzed adolescents' self-reported reasons for not trying DMHIs as a function of distress.

RESULTS

The proportion of adolescents reporting elevated psychological distress (∼50%) was higher than those adopting counseling services (<20%) or DMHIs (<10%). A higher level of distress was associated with a greater likelihood of receiving counseling (OR = 1.15), and using DMHIs to connect with a professional (Odds ratio (OR) = 1.11) and for self-help (OR = 1.17). Among those experiencing high distress, adolescents' top reason for not adopting an online tool was a lack of perceived need (19.2%).

CONCLUSION

Adolescents' main barriers to DMHI adoption included a lack of perceived need, which may be explained by a lack of mental health literacy. Thoughtful marketing and dissemination efforts are needed to increase mental health awareness and normalize adoption of counseling services and DMHIs.

Evaluating professionals' adaptations before and after a decision support intervention "the Adaptation and Fidelity Tool" (A-FiT)-A longitudinal within-person intervention design

Background

Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI (n = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi2-test.

Results

The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer "removing," "substituting," and "integrating another framework" adaptations and more "loosening structure" and "departing from the intervention" adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency.

Conclusions

The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.

Implementation-effectiveness of the power over pain portal for patients awaiting a tertiary care consultation for chronic pain: A pilot feasibility study

Background

The Power Over Pain (POP) Portal is a digital platform that provides people living with pain (PLWP) flexible access to chronic pain self-management resources.

Aims

To (1) determine the feasibility of an adequately-powered multisite trial of the POP Portal in tertiary settings; (2) understand the acceptability and usability of the POP Portal; and (3) explore clinical effectiveness among PLWP awaiting a first visit to a tertiary care pain clinic.

Methods

Mixed-methods pilot-feasibility study to inform a future definitive trial. Feasibility was assessed using recruitment and retention rates. Acceptability, usability, and patient outcomes were measured using validated surveys completed at baseline and 3-month follow-up, and semistructured interviews conducted after 3-month follow-up.

Results

Forty-one participants completed follow-up surveys and nine completed interviews. We reached a recruitment and retention rate of 83.75% and 61.19%, respectively. There was a reduction in pain interference (p = .024) and belief in a medical cure (p = .033) after using POP for 3 months. Surveys and interviews indicate PLWP were satisfied with the POP Portal, and it had good usability. Some participants indicated that POP was overwhelming, and certain resources were difficult to access, indicating that modifications could be made to improve ease of use.

Conclusions

The POP Portal was deemed acceptable with good usability; however, modification may be made for improvement. A definitive trial can proceed with enhancements to the portal, modification of the protocol, and close monitoring.

Transition Guide Dissemination to Foster Patient-Care Team Conversations: A Childhood Arthritis Rheumatology Research Alliance Transition Learning Collaborative Pilot Implementation Study

OBJECTIVE

Uptake of evidence-informed health care transition processes among pediatric rheumatologists is low despite poor outcomes of transition from pediatric to adult care. We piloted a learning collaborative model to implement transition guides. We dually assessed implementation outcomes and changes in reported patient-care team discussions about transition.

METHODS

This was a type II hybrid effectiveness-implementation pilot study of transition guide dissemination to patients at least 14 years old with rheumatic conditions across nine pediatric rheumatology centers in the Childhood Arthritis Rheumatology Research Alliance Transition Learning Collaborative. We evaluated implementation outcomes (feasibility, adaptations, and fidelity) and the proportion of patients surveyed that reported having discussions with their care team regarding transfer planning.

RESULTS

Six sites were retained through the COVID-19 pandemic (below 70% target). Five out of six sites contributed outcome data (met 80% target) but with substantial heterogeneity in how transition guides were shared (eg, in-person, electronic messages, and posted flyers), and data were collected. The pooled proportion of respondents having discussed transfer planning with their care team was 39% preimplementation (n = 239; 95% confidence interval [CI] 32%-46%) and 55% postimplementation (n = 864; 95% CI 36%-73%). After implementation, there were significant increases in the likelihood of respondents recalling receiving a transition guide (odds ratio [OR] 2.58, 95% CI 1.35-4.92) and discussing transfer planning (OR 2.14, 95% CI 1.30-3.52), adjusted for age and site of care.

CONCLUSION

Transition guide dissemination is a simple intervention associated with increased awareness among young people with rheumatic conditions and discussions with their care team about transition preparation. The learning collaborative model facilitated identification of several dissemination strategies adaptable to site-specific resources.

Implementation strategies of fall prevention interventions in hospitals: a systematic review

BACKGROUND

The effectiveness of implementing fall prevention interventions (FPI) among hospitalised adults exhibits variability. Our review explored implementation strategies for FPIs, how these strategies are operationalised and their impact on fall rates and adherence.

METHODS

Databases were searched up to October 2024 for studies reporting the implementation of FPIs in hospitalised adults. Studies were eligible if they reported at least one implementation strategy, reported a fall rate per 1000 patient days and had a control group. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) taxonomy, and operationalised based on the prerequisites of Proctor.

RESULTS

The implementation strategies from the 48 included studies could all be categorised in the existing ERIC strategies. Almost all studies (96%) used at least one implementation strategy from the 'train and educate stakeholders' domain. The second-most used domain was 'develop stakeholder relationships'. The median number of implementation strategies per study was 6 (IQR 4-9). None of the studies reported all prerequisites per individual strategy, we found a median number of prerequisites per strategy of 2 (IQR 1-3). The action was discerned for all implementation strategies, since this was how we identified the implementation strategies. The actor was identified in 47% of the strategies, while all other prerequisites were reported less frequently. After the implementation of FPIs, the median decline in fall rate was 0.9 (IQR -1.8-.3) per 1000 patient days. Across the 17 studies that measured adherence, the median adherence rate to the FPIs was 65% (IQR 29-87).

CONCLUSION

This review emphasises that the documented strategies for implementing FPIs do not provide adequate details in their reporting. This, in turn, hinders clinicians and researchers from optimally guiding their quality improvement projects.

PROSPERO REGISTRATION NUMBER

CRD42018091173.

Blueprint for Enhancing Implementation Quality of Criança Feliz Program in Brazil: A Combined Program Impact Pathways-ERIC Approach

Brazil's Criança Feliz Program is one of the largest early childhood development home-visiting programs globally. After seven years of scaling up, implementation barriers across diverse municipality settings prevented the program from achieving the intended impact on parenting skills and child development. We conducted a program impact pathway analysis to generate a blueprint to enhance implementation quality by (1) identifying the critical quality control points that need to be monitored throughout the scaling up and (2) specifying implementation strategies for enhancing implementation quality. The program impact pathway analysis consisted of inductive and deductive coding of pre-existing retrospective (e.g. reports, and codebooks from in-depth interviews) and workshop with national team to identify the critical quality control points and corresponding implementation barriers and facilitators. The Expert Recommendations for Implementation Change taxonomy was used to specify implementation strategies facilitating the scaling up or opportunities to address barriers across critical quality control points. We identified seven critical quality control points: hiring municipal workforce; staff training; home visits; complementary multisectoral actions; municipal supervision; technical assistance and monitoring; and funding. Implementation strategies facilitating the scale-up were "providing assistance" and "supporting teams;" opportunities for enhancing implementation quality were "financial strategies" and "evaluative and iterative strategies." Our analysis identified seven critical quality control points necessary to achieve the intended implementation and program outcomes. The combined use of the program impact pathway and the Expert Recommendations for Implementation Change taxonomy generated a meaningful blueprint of implementation strategies to enhance implementation quality, which may support the sustainability of a large-scale program.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-024-00141-7.

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.

Blurring the lines: an empirical examination of the interrelationships among acceptability, appropriateness, and feasibility

BACKGROUND

Acceptability, appropriateness, and feasibility are established implementation outcomes used to understand stakeholders' perceptions of an intervention. Further, they are thought to provide insight into behaviors, such as adoption. To date, measurement instruments for the three outcomes have focused on their individual assessment whilst nodding to the idea that they may interrelate. Despite this acknowledgment, there is little empirical evidence of the association among these constructs. Using the example of genetic health professionals providing additional genomic results to patients, this study aimed to examine the interrelationships among acceptability, appropriateness, and feasibility.

METHODS

A sequential explanatory mixed methods approach was employed. All genetic counsellors and clinical geneticists involved in a large research program were invited to complete pre/post surveys using existing measures of acceptability, appropriateness, and feasibility. Follow-up interviews, informed by the survey results, explored clinicians' perspectives of the three outcomes in relation to providing additional genomic results to patients. To categorize interrelationships and generate feedback loops, survey data were analyzed using descriptive and correlation statistics and interpreted alongside interview data analyzed using content analysis.

RESULTS

The survey results (pre n = 53 and post n = 40) for each outcome showed a similar midpoint mean, wide ranges, and little change post implementation (Acceptability: pre M = 3.55, range 2-5 post M = 3.56, range 1.5-5; Appropriateness: pre M = 3.35, range 1-5, post M = 3.48, range 1-5; Feasibility: pre M = 3.30, post M = 3.32; range 1.25-5). The strength of correlation among outcomes ranged from 0.54 to 0.78. Five interrelationships were categorized from analysis of interview data (n = 14) and explain how clinicians' perceptions of the intervention, positive or negative, were determined by interrelating factors of acceptability, appropriateness, and feasibility and that in different scenarios, the function and emphasis of importance among outcomes switched.

CONCLUSIONS

Rather than existing separately, our study promotes the need to consider interrelationships among acceptability, appropriateness, and feasibility to better characterize clinicians' perceptions of complex health care interventions and aid in the development of implementation strategies that have real world impact. Further, in the interest of reducing research waste, more research is needed to determine if the outcomes could serve as proxies for each other.

Current Implementation of Digital Health in Chronic Disease Management: Scoping Review

BACKGROUND

Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated.

OBJECTIVE

This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors.

METHODS

We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data.

RESULTS

A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were "obtain and use patient or consumer feedback" (196/252, 77.8%); "audit and provide feedback" (106/252, 42.1%); and piloting before implementation or "stage implementation scale-up" (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs.

CONCLUSIONS

This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them.

Sustainable implementation efforts in physio- and occupational therapy: a scoping review

BACKGROUND

Health care professionals often fail to adhere to evidence-based guidelines. The implementation of evidence-based methods in health care requires systematic support, but it is still unclear which strategies support professional adherence to clinical practice guidelines. Behavior change techniques can contribute to a more detailed description of implementation strategies. The aim of this scoping review was to explore the nature of studies investigating the sustainability of physiotherapists' (PTs') and occupational therapists' (OTs') clinical behavior when implementing evidence-based methods in health care. Two research questions were addressed: (1) Which implementation strategies are used in studies that have experienced sustained and unsustained changes in the clinical behavior of PTs and OTs? (2) Which behavior change techniques are used in studies involving sustained and unsustained changes in the clinical behavior of PTs and OTs?

METHODS

The scoping review was carried out in accordance with recommendations and the PRISMA-ScR checklist. Six databases were searched. Studies evaluating changes in the clinical behavior of PTs or OTs before and at least 6 months after the end of an implementation intervention were included.

RESULTS

A total of 5130 studies were screened, and 29 studies were included. Twenty-one studies reported sustained results, and 8 studies reported unsustained results. The studies reporting sustained clinical behavior used in median 7 implementation strategies, 45% used a 12-24-month implementation support period, and 86% of the interventions were theory-based. Twenty-two implementation strategies were identified among the included studies. Only two of these defined the implementation strategies in terms of behavior change techniques.

CONCLUSIONS

Studies reporting sustained results were characterized by the use of longer implementation periods, more implementation strategies, more theory-based interventions, and more behavior change techniques. Audit and feedback, resources, problem solving, and communities of practice were implementation strategies, and problem solving, demonstration of behavior, and social support were behavior change techniques that were more common in studies with sustained results of PTs' and OTs' clinical behavior. Our study also highlights the importance of well-described implementation studies.

REGISTRATION

The protocol for the scoping review has been registered in the Open Science Framework, OSF registry ( https://doi.org/10.17605/OSF.IO/DUYQM ).

Assessing local service providers' needs for scaling up MHPSS interventions for Ukrainian refugees: Insights from Poland, Slovakia, and Romania

Providing Mental Health and Psychosocial Support interventions (MHPSS) for forcibly displaced Ukrainians in Central and Eastern Europe poses numerous challenges due to various socio-cultural and infrastructural factors. This qualitative study explored implementation barriers reported by service providers of in-person and digital MHPSS for Ukrainian refugees displaced to Poland, Romania and Slovakia due to the war. In addition, the study aimed to generate recommendations to overcome these barriers. Semi-structured Free List and Key Informant interviews were conducted using the Design, Implementation, Monitoring and Evaluation protocol with 18 and 13 service providers, respectively. For in-person interventions, barriers included stigma, language, shortage of MHPSS providers, lack of financial aid and general lack of trust among refugees. For digital MHPSS, barriers included generational obstacles, lack of therapeutic relationships, trust issues, and lack of awareness. Recommendations included advancing public health strategies, organizational interventions, building technical literacy and support, enhancing the credibility of digital interventions and incorporating MHPSS into usual practice. By implementing the recommendations proposed in this study, policymakers, organizations and service providers can work towards enhancing the delivery of MHPSS and addressing the mental health needs of Ukrainian refugees in host countries, such as Poland, Romania and Slovakia.