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Ojute F, Gonzales PA, Berler M, Puente N, Johnston B, Singh D, Edwards A, Lin J, Lebares C. Identifying Novel Inhibitors of Workplace Support and the Importance of Value Congruence and Feeling Valued in General Surgery Residency Training. J Surg Educ 2024; 81:804-815. [PMID: 38658309 DOI: 10.1016/j.jsurg.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To explore residents' perceptions of workplace support inhibitors and their relationship to resident wellbeing. We aim to provide evidence-based targets to inform future work operationalizing support in surgical training. DESIGN This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1, May 2022) to assess the association between perceived workplace support (e.g. feeling valued and value congruence) and poor individual global wellbeing (e.g. languishing). SETTING National multi-center study including 16 ACGME-accredited academic programs. PARTICIPANTS General surgery residents at all training levels, both clinical and research years. RESULTS 28 residents participated in the focus groups which revealed three major themes around perceived inhibitors of workplace support: lack of trust in residency program (e.g. ulterior motives), poor communication from leadership (e.g. lack of transparency, ineffective dialogue), and unfair systems in residency training (e.g. exploitation of residents, paternal leave policies). These themes emphasized the importance of feeling valued and value congruence, with the latter reflected in the form of trust and communication with leadership, a key element of worker-workplace alignment. 251 residents responded to the survey (response rate 31%, 50.6% women) which revealed that a lower sense of feeling valued and lower perceived value congruence were significantly associated with languishing. CONCLUSIONS Our findings suggest feeling valued and value congruence (specifically, having trust and communication with leadership) are important targets for increasing workplace support in surgical training, offering evidence-based targets for future work to operationalize support in surgical training.
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Affiliation(s)
- Feyisayo Ojute
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Paul Adam Gonzales
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Michael Berler
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Nicole Puente
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Brianna Johnston
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Damin Singh
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Anya Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Joseph Lin
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carter Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
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Fujioka M, Okamoto R, Miyamoto K, Koide K, Kageyama M, Saeki K, Hirokane K, Nagano F, Takemura S. Best practice transfer by public health nurses in Japan: actual conditions and related factors. BMC Nurs 2024; 23:253. [PMID: 38649995 PMCID: PMC11034165 DOI: 10.1186/s12912-024-01800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/14/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. METHODS An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. RESULTS One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. CONCLUSIONS Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.
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Affiliation(s)
- Mana Fujioka
- Former Division of Health Sciences, Osaka University Graduate School of Medicine , Yamadaoka 1-7, 565-0871, Suita-city, Osaka, Japan
| | - Reiko Okamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan.
| | - Keiko Miyamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Keiko Koide
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Masako Kageyama
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Kazuko Saeki
- Faculty of Nursing, Toyama Prefectural University, Nishi-nagae 2-2-78, 930-0975, Toyama-city, Toyama, Japan
| | - Kazue Hirokane
- Faculty of Nursing, Hyogo Medical University, Minatojima 1-3-6, Chuo-ku, 650-8530, Kobe-city, Hyogo, Japan
| | - Fusami Nagano
- Faculty of Nursing, Fukuyama Heisei University, Kamiiwanari-syoto 117-1, Miyuki-town, 720-0001, Fukuyama-city, Hiroshima, Japan
| | - Shinji Takemura
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako-city-minami 2-3-6, 351-0197, Wako-city, Saitama, Japan
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Abstract
OBJECTIVE To provide guiding principles and recommendations for how approaches from the field of dissemination and implementation (D&I) science can advance healthcare equity. DATA SOURCES AND STUDY SETTING This article, part of a special issue sponsored by the Agency for Healthcare Research and Quality (AHRQ), is based on an outline drafted to support proceedings of the 2022 AHRQ Health Equity Summit and further revised to reflect input from Summit attendees. STUDY DESIGN This is a narrative review of the current and potential applications of D&I approaches for understanding and advancing healthcare equity, followed by discussion and feedback with Summit attendees. DATA COLLECTION/EXTRACTION METHODS We identified major themes in narrative and systematic reviews related to D&I science, healthcare equity, and their intersections. Based on our expertise, and supported by synthesis of published studies, we propose recommendations for how D&I science is relevant for advancing healthcare equity. We used iterative discussions internally and at the Summit to refine preliminary findings and recommendations. PRINCIPAL FINDINGS We identified four guiding principles and three D&I science domains with strong promise for accelerating progress toward healthcare equity. We present eight recommendations and more than 60 opportunities for action by practitioners, healthcare leaders, policy makers, and researchers. CONCLUSIONS Promising areas for D&I science to impact healthcare equity include the following: attention to equity in the development and delivery of evidence-based interventions; the science of adaptation; de-implementation of low-value care; monitoring equity markers; organizational policies for healthcare equity; improving the economic evaluation of implementation; policy and dissemination research; and capacity building.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel C. Shelton
- Department of Sociomedical SciencesColumbia University, Mailman School of Public HealthNew YorkNew YorkUSA
| | - Shiriki Kumanyika
- Drexel Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Debra Haire‐Joshu
- Brown School of Public Health and School of MedicineWashington University in St. LouisSt. LouisMissouriUSA
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Daniels K, Lemmens R, Knippenberg E, Marinus N, Vonck S, Baerts J, Bergs J, Spooren A, Hansen D, Bonnechère B. Promoting physical activity and a healthy active lifestyle in community-dwelling older adults: a design thinking approach for the development of a mobile health application. Front Public Health 2023; 11:1280941. [PMID: 38106904 PMCID: PMC10724027 DOI: 10.3389/fpubh.2023.1280941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background Physical activity (PA) has wide-ranging, and well documented benefits for older adults, encompassing physical, cognitive, and mental well-being. The World Health Organization advocates for a minimum of 150-300 min of moderate intensity PA per week, supplemented by muscle-strengthening exercises. However, the rates of PA among older adults remain a concern. While portable technologies hold promises in promoting PA, sustaining long-term engagement continues to be a challenge. Objective The aims of this study are to identify barriers and facilitators to PA in older adults, to develop an mHealth app promoting PA and an active healthy lifestyle in collaboration with community-dwelling older adults guided by the design thinking process, and to test it. Methods A co-creative process was used, employing design thinking. Interviews were conducted to understand the needs of the target population and identify the problem of insufficient PA. Two cocreation sessions involving older adults and experts were conducted to generate innovative ideas. Participants were selected based on age (≥65 years), no severe illness, Dutch language proficiency, and active participation ability. Results were qualitatively analyzed and coded. Finally a prototype was developed and tested. Results Interviews with older adults highlighted diverse perceptions of PA but unanimous agreement on its importance. They recognized health benefits such as improved mobility, balance, and reduced fall risk, while emphasizing the social and mental aspects. Barriers included poor health, time constraints, weather conditions and fear of falling. Cocreation sessions identified key topics: perception of a healthy lifestyle, coping strategies, mHealth App features, screen visualization, and tailored notifications, which led to the development of a mobile app promoting PA and an active lifestyle. The app was stepwise prototyped. Conclusion This study emphasizes the importance of promoting PA among older adults through a collaborative design thinking approach. However, the implementation of mHealth apps faces obstacles due to the digital divide, necessitating personalized solutions to bridge the gap. Moreover, it calls for further research to investigate the long-term impact of such interventions and explore behavior change patterns in this population.
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Affiliation(s)
- Kim Daniels
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ryanne Lemmens
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Els Knippenberg
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Nastasia Marinus
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Sharona Vonck
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Jan Baerts
- Department of Digital, PXL University College of Applied Sciences and Arts, Hasselt, Belgium
| | - Jochen Bergs
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- THINK3 Simulation & Innovation Lab, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Annemie Spooren
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bruno Bonnechère
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
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Hamer MK, Sobczak C, Whittington L, Bowyer RL, Koren R, Begay JA, Lum HD, Ginde AA, Wynia MK, Kwan BM. Real-world data to evaluate effects of a multi-level dissemination strategy on access, outcomes, and equity of monoclonal antibodies for COVID-19. J Clin Transl Sci 2023; 7:e258. [PMID: 38229899 PMCID: PMC10789982 DOI: 10.1017/cts.2023.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Multi-level dissemination strategies are needed to increase equitable access to effective treatment for high-risk outpatients with COVID-19, particularly among patients from disproportionately affected communities. Yet assessing population-level impact of such strategies can be challenging. Methods In collaboration with key contributors in Colorado, we conducted a retrospective cohort study to evaluate a multi-level dissemination strategy for neutralizing monoclonal antibody (mAb) treatment. Real-world data included county-level, de-identified output from a statewide mAb referral registry linked with publicly available epidemiological data. Outcomes included weekly number of mAb referrals, unique referring clinicians, and COVID-19 hospitalization rates. We assessed weekly changes in outcomes after dissemination strategies launched in July 2021. Results Overall, mAb referrals increased from a weekly average of 3.0 to 15.5, with an increase of 1.3 to 42.1 additional referrals per county in each post-period week (p < .05). Number of referring clinicians increased from a weekly average of 2.2 to 9.7, with an additional 1.5 to 22.2 unique referring clinicians observed per county per week beginning 5 weeks post-launch (p < .001). Larger effects were observed in communities specifically prioritized by the dissemination strategies. There were no observed differences in COVID-19 hospitalization rates between counties with and without mAb treatment sites. Conclusion Real-world data can be used to estimate population impact of multi-level dissemination strategies. The launch of these strategies corresponded with increases in mAb referrals, but no apparent population-level effects on hospitalization outcomes. Strengths of this analytic approach include pragmatism and efficiency, whereas limitations include inability to control for other contemporaneous trends.
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Affiliation(s)
- Mika K. Hamer
- Center for Bioethics and Humanities, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Chelsea Sobczak
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | | | | | - Ramona Koren
- Patient Partner/Community Affiliate, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Joel A. Begay
- Johns Hopkins Center for Indigenous Health, Department of International
Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine,
University of Colorado School of Medicine, Aurora,
CO, USA
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado
School of Medicine, Aurora, CO,
USA
- Colorado Clinical & Translational Sciences Institute,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Matthew K. Wynia
- Center for Bioethics and Humanities, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
- Colorado Clinical & Translational Sciences Institute,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado
School of Medicine, Aurora, CO,
USA
| | - Bethany M. Kwan
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
- Department of Emergency Medicine, University of Colorado
School of Medicine, Aurora, CO,
USA
- Colorado Clinical & Translational Sciences Institute,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
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Kilbourne A, Chinman M, Rogal S, Almirall D. Adaptive Designs in Implementation Science and Practice: Their Promise and the Need for Greater Understanding and Improved Communication. Annu Rev Public Health 2023; 45:10.1146/annurev-publhealth-060222-014438. [PMID: 37931183 PMCID: PMC11070446 DOI: 10.1146/annurev-publhealth-060222-014438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The promise of adaptation and adaptive designs in implementation science has been hindered by the lack of clarity and precision in defining what it means to adapt, especially regarding the distinction between adaptive study designs and adaptive implementation strategies. To ensure a common language for science and practice, authors reviewed the implementation science literature and found that the term adaptive was used to describe interventions, implementation strategies, and trial designs. To provide clarity and offer recommendations for reporting and strengthening study design, we propose a taxonomy that describes fixed versus adaptive implementation strategies and implementation trial designs. To improve impact, (a) future implementation studies should prespecify implementation strategy core functions that in turn can be taught to and replicated by health system/community partners, (b) funders should support exploratory studies that refine and specify implementation strategies, and (c) investigators should systematically address design requirements and ethical considerations (e.g., randomization, blinding/masking) with health system/community partners. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amy Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
- Department of Learning Health Science, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Matthew Chinman
- RAND Corporation, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Shari Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
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Lovero KL, Kemp CG, Wagenaar BH, Giusto A, Greene MC, Powell BJ, Proctor EK. Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review. Implement Sci 2023; 18:56. [PMID: 37904218 PMCID: PMC10617067 DOI: 10.1186/s13012-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. METHODS We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. RESULTS The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings (n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1-46 strategies) included in each study. Most studies (n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. CONCLUSIONS While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. TRIAL REGISTRATION PROSPERO, CRD42021268374.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Greene
- Program On Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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Obita G, Alkhatib A. Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15112524. [PMID: 37299488 DOI: 10.3390/nu15112524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
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Cabilan CJ, McRae J, Ganzon K, Appo C, Rogers S, O'Sullivan M, Eley R, Snoswell C, Johnston A. Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study. J Emerg Nurs 2023; 49:360-370. [PMID: 36872199 DOI: 10.1016/j.jen.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.
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Lennerz JK, Salgado R, Kim GE, Sirintrapun SJ, Thierauf JC, Singh A, Indave I, Bard A, Weissinger SE, Heher YK, de Baca ME, Cree IA, Bennett S, Carobene A, Ozben T, Ritterhouse LL. Diagnostic quality model (DQM): an integrated framework for the assessment of diagnostic quality when using AI/ML. Clin Chem Lab Med 2023; 61:544-557. [PMID: 36696602 DOI: 10.1515/cclm-2022-1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laboratory medicine has reached the era where promises of artificial intelligence and machine learning (AI/ML) seem palpable. Currently, the primary responsibility for risk-benefit assessment in clinical practice resides with the medical director. Unfortunately, there is no tool or concept that enables diagnostic quality assessment for the various potential AI/ML applications. Specifically, we noted that an operational definition of laboratory diagnostic quality - for the specific purpose of assessing AI/ML improvements - is currently missing. METHODS A session at the 3rd Strategic Conference of the European Federation of Laboratory Medicine in 2022 on "AI in the Laboratory of the Future" prompted an expert roundtable discussion. Here we present a conceptual diagnostic quality framework for the specific purpose of assessing AI/ML implementations. RESULTS The presented framework is termed diagnostic quality model (DQM) and distinguishes AI/ML improvements at the test, procedure, laboratory, or healthcare ecosystem level. The operational definition illustrates the nested relationship among these levels. The model can help to define relevant objectives for implementation and how levels come together to form coherent diagnostics. The affected levels are referred to as scope and we provide a rubric to quantify AI/ML improvements while complying with existing, mandated regulatory standards. We present 4 relevant clinical scenarios including multi-modal diagnostics and compare the model to existing quality management systems. CONCLUSIONS A diagnostic quality model is essential to navigate the complexities of clinical AI/ML implementations. The presented diagnostic quality framework can help to specify and communicate the key implications of AI/ML solutions in laboratory diagnostics.
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Affiliation(s)
- Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
- Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - Grace E Kim
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | | | - Julia C Thierauf
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, German Cancer Research Center (DKFZ), Heidelberg University Hospital and Research Group Molecular Mechanisms of Head and Neck Tumors, Heidelberg, Germany
| | - Ankit Singh
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
| | - Iciar Indave
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Adam Bard
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
| | | | - Yael K Heher
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
| | | | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Shannon Bennett
- Department of Laboratory Medicine and Pathology (DLMP), Mayo Clinic, Rochester, MN, USA
| | - Anna Carobene
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tomris Ozben
- Medical Faculty, Dept. of Clinical Biochemistry, Akdeniz University, Antalya, Türkiye
- Medical Faculty, Clinical and Experimental Medicine, Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Lauren L Ritterhouse
- Department of Pathology, Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
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11
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Karabukayeva A, Hearld LR, Kelly R, Hall A, Singh J. Association between the number of adopted implementation strategies and contextual determinants: a mixed-methods study. BMC Health Serv Res 2022; 22:1518. [PMID: 36514102 PMCID: PMC9746001 DOI: 10.1186/s12913-022-08736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The successful implementation of evidence-based innovations to improve healthcare delivery often requires a well-planned strategy to support their use. With a greater recognition of the importance of an implementation process, researchers have turned their attention to implementation strategies and their customization to target specific organizational barriers and facilitators. Further, there is a paucity of empirical evidence demonstrating the link between implementation determinants and the number of selected implementation strategies. The purpose of this mixed methods analysis is to examine how formatively assessed barriers and facilitators to implementation relate to the number and type of implementation strategies adopted to address context-specific factors. METHODS A mixed methods evaluation that included 15 rheumatology clinics throughout the United States that were planning for implementation of an evidence-based shared decision-making aid for patients with lupus. Quantitative data consisted of a count of the number of implementation strategies used by a clinic. Qualitative data collection was guided by the Consolidated Framework for Implementation Research (CFIR) and relied upon semi-structured interviews with 90 clinic members between November 2018 and August 2019. RESULTS Using the CFIR, we found that local clinic factors (Inner Setting Domain) resulted in different perceptions about Planning and Executing the DA (Process Domain); these domains were most likely to distinguish between the number and type of implementation strategies adopted by the clinics. In contrast, Intervention characteristics, Individual Characteristics, and the Outer Setting did not differentiate between the groups with different numbers of implementation strategies. The number and type of chosen strategies were not those associated with the context-specific factors. CONCLUSIONS Findings show that, despite recognition of the value of customizing implementation strategies for the contexts in which they are applied, they are too often chosen in a manner that fail to adequately reflect the diverse settings that may present unique factors associated with implementation. Our findings also highlight the importance of the inner context - both in terms of structural characteristics and existing work processes - as a driving factor for why some organizations select different numbers and types of implementation strategies.
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Affiliation(s)
- Aizhan Karabukayeva
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Larry R. Hearld
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Reena Kelly
- grid.266831.80000 0001 2168 8754Department of Health Administration & Policy, School of Health Sciences, University of New Haven, West Haven, CT 06516 USA
| | - Allyson Hall
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Jasvinder Singh
- grid.265892.20000000106344187Division of Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35222 USA
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12
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Williams NJ, Preacher KJ, Allison PD, Mandell DS, Marcus SC. Required sample size to detect mediation in 3-level implementation studies. Implement Sci 2022; 17:66. [PMID: 36183090 PMCID: PMC9526963 DOI: 10.1186/s13012-022-01235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Statistical tests of mediation are important for advancing implementation science; however, little research has examined the sample sizes needed to detect mediation in 3-level designs (e.g., organization, provider, patient) that are common in implementation research. Using a generalizable Monte Carlo simulation method, this paper examines the sample sizes required to detect mediation in 3-level designs under a range of conditions plausible for implementation studies. Method Statistical power was estimated for 17,496 3-level mediation designs in which the independent variable (X) resided at the highest cluster level (e.g., organization), the mediator (M) resided at the intermediate nested level (e.g., provider), and the outcome (Y) resided at the lowest nested level (e.g., patient). Designs varied by sample size per level, intraclass correlation coefficients of M and Y, effect sizes of the two paths constituting the indirect (mediation) effect (i.e., X→M and M→Y), and size of the direct effect. Power estimates were generated for all designs using two statistical models—conventional linear multilevel modeling of manifest variables (MVM) and multilevel structural equation modeling (MSEM)—for both 1- and 2-sided hypothesis tests. Results For 2-sided tests, statistical power to detect mediation was sufficient (≥0.8) in only 463 designs (2.6%) estimated using MVM and 228 designs (1.3%) estimated using MSEM; the minimum number of highest-level units needed to achieve adequate power was 40; the minimum total sample size was 900 observations. For 1-sided tests, 808 designs (4.6%) estimated using MVM and 369 designs (2.1%) estimated using MSEM had adequate power; the minimum number of highest-level units was 20; the minimum total sample was 600. At least one large effect size for either the X→M or M→Y path was necessary to achieve adequate power across all conditions. Conclusions While our analysis has important limitations, results suggest many of the 3-level mediation designs that can realistically be conducted in implementation research lack statistical power to detect mediation of highest-level independent variables unless effect sizes are large and 40 or more highest-level units are enrolled. We suggest strategies to increase statistical power for multilevel mediation designs and innovations to improve the feasibility of mediation tests in implementation research. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01235-2.
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Affiliation(s)
- Nathaniel J Williams
- Institute for the Study of Behavioral Health and Addiction, Boise State University, 1910 University Drive, Boise, ID, 83725-1940, USA. .,School of Social Work, Boise State University, Boise, ID, USA.
| | - Kristopher J Preacher
- Department of Psychology & Human Development, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203-5721, USA
| | - Paul D Allison
- Statistical Horizons LLC, P.O. Box 282, Ardmore, PA, 19003, USA
| | - David S Mandell
- Penn Center for Mental Health, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA, USA
| | - Steven C Marcus
- Penn Center for Mental Health, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA.,School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA
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13
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Ritchie MJ, Drummond KL, Smith BN, Sullivan JL, Landes SJ. Development of a qualitative data analysis codebook informed by the i-PARIHS framework. Implement Sci Commun 2022; 3:98. [PMID: 36104801 PMCID: PMC9476709 DOI: 10.1186/s43058-022-00344-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and research. Codebooks with clear and meaningful code labels and definitions are an important component of qualitative data analysis and have been developed for other widely used frameworks. There is no such codebook for i-PARIHS. Additionally, sub-constructs for the Innovation, Recipients, and Context constructs lack definitions, and there is no sub-classification of facilitation activities for the Facilitation construct. The lack of a standardized codebook hinders our ability to synthesize research findings across studies, explore and test the range of activities that are utilized in facilitation efforts, and potentially validate and further refine i-PARIHS. This paper describes a rigorous process of developing a detailed qualitative codebook informed by the i-PARIHS framework. Methods A workgroup of qualitative researchers conducted a rigorous four-phase process to develop a codebook informed by i-PARIHS. In phase 1, workgroup members reviewed and discussed literature, consulted an organizational scientist, and drafted and refined subcodes and definitions for i-PARIHS constructs. In phase 2, they obtained feedback from an expert panel and further refined subcodes and definitions. In phase 3, they obtained feedback from i-PARIHS developers/experts and incorporated it into the codebook. Finally, two studies piloted the application of the codebook which informed the final version. Results The resulting i-PARIHS-informed codebook includes definitions for the four main constructs of the framework: Innovation, Recipients, Context, and Facilitation; subcodes and definitions for characteristics of each of these constructs; and instructions for the suggested application of individual codes and use of the codebook generally. Conclusions The standardized codes and definitions in the codebook can facilitate data exploration, pattern identification, and insight development informed by the i-PARIHS framework. Qualitative analysts can also use them to explore interactions between i-PARIHS constructs, maximize the potential for comparing findings across studies, and support the refinement of the i-PARIHS framework using empirical findings from multiple studies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00344-9.
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Abstract
PURPOSE Implementation science aims to facilitate the use of evidence-based programs, practices, and policies in routine care settings. In audiology, as in other health disciplines, there is a persistent research-to-practice gap. Improving the adoption, reach, implementation, and sustainment of effective interventions in audiology would increase their public health impact, ensuring that all individuals needing hearing health care services could benefit from innovations and evidence-based best practices. This tutorial provides an introductory overview of implementation science relevant to the field of audiology, including Internet-based practices and interventions. METHOD Major concepts and themes of implementation science are presented, including implementation outcomes, implementation science frameworks, implementation strategies, current topics in implementation science, and study design considerations. Recent publications in audiology are highlighted to illustrate implementation science concepts and themes. The relevance of each topic to the use of evidence-based programs, practices, and policies in audiology is highlighted with reference to recent research in the field. CONCLUSIONS Challenges in the widespread delivery of evidence-based audiological practices and interventions limit their public health impact. The application of implementation science principles and methods in audiology research, as demonstrated in other areas of health research, can increase our focus on ensuring that effective practices are widely available, accessible, equitable, and sustainable to improve the lives of those who need them.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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15
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MCLOUGHLIN GABRIELLAM, MARTINEZ OMAR. Dissemination and Implementation Science to Advance Health Equity: An Imperative for Systemic Change. Commonhealth (Phila) 2022; 3:75-86. [PMID: 35811831 PMCID: PMC9262159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Innovations in public health research and evidence-based interventions targeting chronic and infectious diseases are only effective if they reach their target populations. Individuals from low socioeconomic background, racial and ethnic minorities, and sexual/gender minority communities are most susceptible to chronic diseases such as obesity and cancer, and infectious diseases such as HIV and COVID-19. These disparities are driven by social and structural conditions including stigma and discrimination, housing instability and food insecurity, among others. Accordingly, interventions that aim to improve population health must be targeted toward marginalized communities who are often systematically excluded from decision making processes. This article introduces dissemination and implementation science as a key opportunity to advance health equity through integrating measures and metrics that evaluate if an intervention is successful at improving health outcomes in marginalized populations. Implementation science also provides frameworks to help evaluate the key determinants to implementation success which can inform subsequent health outcomes. Examples of how researchers have engaged with community stakeholders are provided, along with strategies in which dissemination has gone beyond traditional practices. Finally, ways in which universities can build capacity for implementation science as a means to address health disparities are provided with the goal of improving the translation of research to practice.
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Affiliation(s)
- GABRIELLA M. MCLOUGHLIN
- Department of Kinesiology, College of Public Health, Temple University,Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis
| | - OMAR MARTINEZ
- School of Social Work, College of Public Health, Temple University
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16
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Okamoto R, Kageyama M, Koide K, Tanaka M, Yamamoto Y, Fujioka M, Osuna A, Saeki K, Hirokane K, Nagano F, Takemura S. Implementation Degree Assessment Sheet for Health Program in Japan by Customizing CFIR: Development and Validation. Implement Sci Commun 2022; 3:20. [PMID: 35183263 PMCID: PMC8858514 DOI: 10.1186/s43058-022-00270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose More than 70% of public health nurses in Japan belong to government agencies, and there is a need for further evidence-based capacity development for program implementation. The purpose of this research was to develop an Implementation Degree Assessment Sheet (IDAS) by customizing the Consolidated Framework for Implementation Research (CFIR) to health programs in Japan. Methods The draft IDAS (five domains, 31 constructs) created by customizing the CFIR was refined by the researchers and modified through pre-testing. The survey covered full-time public health nurses (PHNs) affiliated to all prefectures and the cities with health centers of Japan. The survey was conducted as an anonymous, self-administered questionnaire survey by mail. Results One hundred eighty-five of the 334 institutions (55.4%) agreed to participate in our survey. Of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. No item required consideration of deletion based on the results of item analysis, and our confirmatory factor analysis on model fitness between the five IDAS domains and CFIR showed sufficient fit indices after modification. With regard to reliability, Cronbach’s coefficient alpha, a measure of internal consistency, stayed above 0.8 overall. Our verification of stability with the split-half (odd/even) method resulted in a Spearman–Brown reliability coefficient of 0.95. The correlation coefficient between the IDAS scores and the research utilization competency score, used as an external criterion, was 0.51 (p<0.001), supporting the coexistence validity of the criterion-related validity of the IDAS. The significant differences were observed between known-groups, supporting the known-group validity of the IDAS. Conclusion This study developed the IDAS and confirmed constant reliability and validity. Hereafter, it is necessary to promote the required capacity development based on the actual degree of implementation in order to use the IDAS for the competency development of public health nurses and related professions to deliver health programs. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00270-w.
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Affiliation(s)
- Reiko Okamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan.
| | - Masako Kageyama
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Keiko Koide
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Miho Tanaka
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Yoshiko Yamamoto
- Former Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mana Fujioka
- Former Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ayami Osuna
- Former Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuko Saeki
- Faculty of Nursing, Toyama Prefectural University, Nishi-nagae 2-2-78, Toyama-city, Toyama, 930-0975, Japan
| | - Kazue Hirokane
- School of Nursing, Hyogo University of Health Sciences, Minatojima 1-3-6, Chuo-ku, Kobe-shi, Hyogo, 650-8530, Japan
| | - Fusami Nagano
- Faculty of Nursing, Fukuyama Heisei University, Kamiiwanari-syoto 117-1, Miyuki-town, Fukuyama-city, Hiroshima, 720-0001, Japan
| | - Shinji Takemura
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako-city-minami 2-3-6, Saitama, 351-0197, Japan
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17
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Tenney L, Huebschmann AG, Brown CE, Schwatka NV, Newman LS. Leveraging an Implementation Science Framework to Measure the Impact of Efforts to Scale Out a Total Worker Health® Intervention to Employers. Int J Environ Res Public Health 2022; 19:ijerph19031372. [PMID: 35162408 PMCID: PMC8834848 DOI: 10.3390/ijerph19031372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022]
Abstract
The role of dissemination and implementation (D&I) science is critical to the translation of Total Worker Health® into practice and to the success of interventions in addressing current and future implications for worker safety, health, and well-being. D&I frameworks can guide researchers to design Total Worker Health (“TWH”) delivery approaches that use flexible implementation strategies to implement the core components of programs for employers with varying contextual factors, including small/mid/large-sized businesses and different industry types. To date, there have been very few examples of applying implementation frameworks for the translation and delivery of interventions into organizational settings that require adoption and implementation at the business level to benefit the working individuals. We present a TWH case study, Health Links™, to illustrate an approach to applying an existing implementation framework, RE-AIM, to plan, design, build, and then evaluate TWH implementation strategies. Our case study also highlights key concepts for scaling-out TWH evidence-based interventions where they are implemented in new workplace settings, new delivery systems, or both. Our example provides strong support of key implementation planning constructs including early and consistent stakeholder engagement, tailored messaging and marketing, flexibility, and adaptations in implementation strategies to maximize adoption, implementation, and maintenance among participating businesses.
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Affiliation(s)
- Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA; (C.E.B.); (N.V.S.); (L.S.N.)
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA
- Correspondence: ; Tel.: +1-303-724-6640
| | - Amy G. Huebschmann
- Adult & Child Consortium for Outcomes Research and Delivery Science (ACCORDS) Dissemination and Implementation Program, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Division of General Internal Medicine and Ludeman Family Center for Women’s Health Research, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carol E. Brown
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA; (C.E.B.); (N.V.S.); (L.S.N.)
| | - Natalie V. Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA; (C.E.B.); (N.V.S.); (L.S.N.)
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA
| | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA; (C.E.B.); (N.V.S.); (L.S.N.)
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119, Aurora, CO 80045, USA
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18
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Abstract
Designing for dissemination and sustainability (D4DS) refers to principles and methods for enhancing the fit between a health program, policy, or practice and the context in which it is intended to be adopted. In this article we first summarize the historical context of D4DS and justify the need to shift traditional health research and dissemination practices. We present a diverse literature according to a D4DS organizing schema and describe a variety of dissemination products, design processes and outcomes, and approaches to messaging, packaging, and distribution. D4DS design processes include stakeholder engagement, participatory codesign, and context and situation analysis, and leverage methods and frameworks from dissemination and implementation science, marketing and business, communications and visual arts, and systems science. Finally, we present eight recommendations to adopt a D4DS paradigm, reflecting shifts in ways of thinking, skills and approaches, and infrastructure and systems for training and evaluation. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Bethany M. Kwan
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine St. Louis, Missouri, USA
| | - Russell E. Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health and Institute for Translational Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Douglas A. Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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19
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Heiden BT, Tetteh E, Robbins KJ, Tabak RG, Nava RG, Marklin GF, Kreisel D, Meyers BF, Kozower BD, McKay VR, Puri V. Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study. Ann Thorac Surg 2021; 114:373-382. [PMID: 34499861 PMCID: PMC9112075 DOI: 10.1016/j.athoracsur.2021.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Dissemination and implementation (D&I) science is the practice of taking evidence-based interventions (EBI) and sustainably incorporating them in routine clinical practice. As a relatively young field, D&I techniques are underutilized in cardiothoracic surgery. This review offers an overview of D&I science from the context of the cardiothoracic surgeon. First, we provide a general introduction to D&I science and basic terminology that is used in the field. Second, to illustrate D&I techniques in a real-world example, we discuss a case study for implementing lung protective management (LPM) strategies for lung donor optimization nationally. Finally, we discuss challenges to successful implementation that are unique to cardiothoracic surgery and give several examples of EBIs that have been poorly implemented into surgical practice. We also provide examples of successful D&I interventions - including de-implementation strategies - from other surgical subspecialties. We hope that this review offers additional tools for cardiothoracic surgeons to explore when introducing EBIs into routine practice.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Emmanuel Tetteh
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Keenan J Robbins
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rachel G Tabak
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO; Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gary F Marklin
- Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Virginia R McKay
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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20
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Suhrheinrich J, Melgarejo M, Root B, Aarons GA, Brookman-Frazee L. Implementation of school-based services for students with autism: Barriers and facilitators across urban and rural districts and phases of implementation. Autism 2021; 25:2291-2304. [PMID: 34132123 DOI: 10.1177/13623613211016729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The law requires that schools use evidence-based practices to educate students with autism spectrum disorder. However, these practices are often not used, or are not used correctly in school programs. Understanding barriers and facilitators of use of evidence-based practices in schools will help improve the implementation process. This study uses focus groups to characterize how school-based providers representing urban or rural school districts perceive barriers and facilitators for implementing new practices for students with autism spectrum disorder. Guiding questions include the following: (1) Are contextual factors perceived as barriers or facilitators and how do these vary by district location? and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases? Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some personnel-related themes and organizational factors were unique to rural or urban districts. For example, themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in identifying implementation strategies that may improve the use of evidence-based practices in schools.
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Affiliation(s)
- Jessica Suhrheinrich
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
| | - Melina Melgarejo
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
| | - Brittney Root
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
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21
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Abstract
Published results of efficacy and effectiveness studies on complementary health approaches should lead to widespread uptake of evidence-based practices, but too often, the scientific pathway ends prematurely, before the best ways to improve adoption, implementation, and sustainability can be determined. The National Center for Complementary and Integrative Health (NCCIH) supports the full continuum of the biomedical research pipeline, whereby a complementary health intervention moves from basic and mechanistic research through efficacy trials and through dissemination and implementation. Implementation science has traditionally been thought of as something that only happens after efficacy and effectiveness have been demonstrated, but it can be prudent to evaluate implementation measures earlier in the process. Implementation science assesses more than just barriers and facilitators; it evaluates specific implementation strategies and characterizes the extent that the intervention is modified within the context of the implementation strategy and health care delivery setting. The best choices for implementation science in complementary health interventions depend on the research questions. Implementation science that tests strategies to address implementation at multiple ecologic levels is a high priority to NCCIH.
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Affiliation(s)
- David Clark
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Emmeline Edwards
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Peter Murray
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Helene Langevin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
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22
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Corradini S, Niyazi M, Verellen D, Valentini V, Walsh S, Grosu AL, Lauber K, Giaccia A, Unger K, Debus J, Pieters BR, Guckenberger M, Senan S, Budach W, Rad R, Mayerle J, Belka C. X-change symposium: status and future of modern radiation oncology-from technology to biology. Radiat Oncol 2021; 16:27. [PMID: 33541387 PMCID: PMC7863262 DOI: 10.1186/s13014-021-01758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Future radiation oncology encompasses a broad spectrum of topics ranging from modern clinical trial design to treatment and imaging technology and biology. In more detail, the application of hybrid MRI devices in modern image-guided radiotherapy; the emerging field of radiomics; the role of molecular imaging using positron emission tomography and its integration into clinical routine; radiation biology with its future perspectives, the role of molecular signatures in prognostic modelling; as well as special treatment modalities such as brachytherapy or proton beam therapy are areas of rapid development. More clinically, radiation oncology will certainly find an important role in the management of oligometastasis. The treatment spectrum will also be widened by the rational integration of modern systemic targeted or immune therapies into multimodal treatment strategies. All these developments will require a concise rethinking of clinical trial design. This article reviews the current status and the potential developments in the field of radiation oncology as discussed by a panel of European and international experts sharing their vision during the "X-Change" symposium, held in July 2019 in Munich (Germany).
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Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Dirk Verellen
- Department of Radiotherapy, Iridium Network, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo Valentini
- Department of Radiation Oncology and Hematology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | | | - Anca-L Grosu
- Department of Radiation Oncology, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Amato Giaccia
- Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Kristian Unger
- Integrative Biology Group, Helmholtz Zentrum Munich, Munich, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Roland Rad
- Center for Translational Cancer Research (TranslaTUM), TU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, University Hospital, LMU, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Rogal SS, Powell BJ, Chinman M. Moving Toward Impact: An Introduction to Implementation Science for Gastroenterologists and Hepatologists. Gastroenterology 2020; 159:2007-2012. [PMID: 32950522 PMCID: PMC7498466 DOI: 10.1053/j.gastro.2020.07.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 12/02/2022]
Affiliation(s)
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and, RAND Corporation, Pittsburgh, Pennsylvania
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24
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Owoeye OBA, Rauvola RS, Brownson RC. Dissemination and implementation research in sports and exercise medicine and sports physical therapy: translating evidence to practice and policy. BMJ Open Sport Exerc Med 2020; 6:e000974. [PMID: 33304607 PMCID: PMC7704287 DOI: 10.1136/bmjsem-2020-000974] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Knowledge from research evidence is wasted unless it is applied. While the scientific evidence base for many sports and exercise medicine and sports physical therapy interventions is robust, real-world implementation and evolution to scale remains an ongoing challenge. Dissemination and implementation research is important to generate evidence-informed, cost-effective and context-specific strategies for implementation partners and stakeholders to effectively apply and sustain the best research evidence in public health and clinical practice. However, this field of inquiry remains underexplored in sports and exercise medicine and sports physical therapy. Most intervention studies in sports and exercise medicine and sports physical therapy are terminated at the efficacy trial stage without considerations for best practices for translation to community and clinical settings. Lack of context-specific dissemination and implementation strategies to drive the translation of evidence-based interventions results in poor execution of, and attrition from, interventions, and this is associated with suboptimal outcomes and increased healthcare costs. Theory-driven quality research informing the successful dissemination and implementation of evidence-based interventions is needed to address lingering evidence-to-practice gaps. Dissemination and implementation research completes the final stage in the research-to-practice pipeline. It seeks to close evidence-to-practice gaps, thereby ensuring speedy application of research evidence to achieve desired public health outcomes while making more efficient use of limited resources. This review introduces sports and exercise medicine and sports physical therapy researchers and stakeholders to key concepts and principles in dissemination and implementation research.
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Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri, USA
| | - Rachel S Rauvola
- Department of Psychology, College of Science and Health, DePaul University, Chicago, Illinois, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School; Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University in Saint Louis, Saint Louis, Missouri, USA
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25
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Rasmussen CDN, Svendsen MJ, Wood K, Nicholl BI, Mair FS, Sandal LF, Mork PJ, Søgaard K, Bach K, Stochkendahl MJ. App-Delivered Self-Management Intervention Trial selfBACK for People With Low Back Pain: Protocol for Implementation and Process Evaluation. JMIR Res Protoc 2020; 9:e20308. [PMID: 33118959 PMCID: PMC7661240 DOI: 10.2196/20308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022] Open
Abstract
Background Implementation and process evaluation is vital for understanding how interventions function in different settings, including if and why interventions have different effects or do not work at all. Objective This paper presents the protocol for an implementation and process evaluation embedded in a multicenter randomized controlled trial conducted in Denmark and Norway (the selfBACK project). selfBACK is a data-driven decision support system that provides participants with weekly self-management plans for low back pain. These plans are delivered through a smartphone app and tailored to individual participants by using case-based reasoning methodology. In the trial, we compare selfBACK in addition to usual care with usual care alone. Methods The aim of this study is to conduct a convergent mixed-methods implementation and process evaluation of the selfBACK app by following the reach, effectiveness, adoption, implementation, and maintenance framework. We will evaluate the process of implementing selfBACK and investigate how participants use the intervention in daily life. The evaluation will also cover the reach of the intervention, health care provider willingness to adopt it, and participant satisfaction with the intervention. We will gather quantitative measures by questionnaires and measures of data analytics on app use and perform a qualitative exploration of the implementation using semistructured interviews theoretically informed by normalization process theory. Data collection will be conducted between March 2019 and October 2020. Results The trial opened for recruitment in February 2019. This mixed-methods implementation and evaluation study is embedded in the randomized controlled trial and will be collecting data from March 2019 to October 2020; dissemination of trial results is planned thereafter. The results from the process evaluation are expected 2021-2022. Conclusions This study will provide a detailed understanding of how self-management of low back pain can be improved and how a digital health intervention can be used as an add-on to usual care to support patients to self-manage their low back pain. We will provide knowledge that can be used to explore the possibilities of extending the generic components of the selfBACK system and key drivers that could be of use in other conditions and diseases where self-management is an essential prevention or treatment strategy. Trial Registration ClinicalTrials.gov NCT03798288; https://www.clinicaltrials.gov/ct2/show/NCT03798288 International Registered Report Identifier (IRRID) DERR1-10.2196/20308
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Affiliation(s)
| | - Malene Jagd Svendsen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Denmark, Odense M, Denmark
| | - Karen Wood
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Barbara I Nicholl
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frances S Mair
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Denmark, Odense M, Denmark
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Denmark, Odense M, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Kerstin Bach
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mette Jensen Stochkendahl
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark
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26
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Lane HG, Turner L, Dunn CG, Hager ER, Fleischhacker S. Leveraging Implementation Science in the Public Health Response to COVID-19 : Child Food Insecurity and Federal Nutrition Assistance Programs. Public Health Rep 2020; 135:728-736. [PMID: 33031712 PMCID: PMC7649993 DOI: 10.1177/0033354920959285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Hannah G. Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID, USA
| | - Caroline Glagola Dunn
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Erin R. Hager
- Division of Growth and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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27
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Abstract
User-centered design (UCD), a discipline that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation, has great potential to improve the translation of evidence-based practices from behavioral medicine research for implementation in health care settings. UCD is a diverse, innovative field that remains highly variable in terms of language and approaches. Ultimately, we produced a glossary of UCD-related strategies specifically for experts in implementation research and practice, with the goal of promoting interdisciplinary collaboration in implementation efforts. We conducted a focused literature review to identify key concepts and specific strategies of UCD to translate into the implementation field. We also categorized the strategies as primarily targeting one or more levels of the implementation process (i.e., interventions, individuals, inner context, and outer context). Ultimately, we produced a glossary of 30 UCD strategies for implementation experts. Each glossary term is accompanied by a short, yet comprehensive, definition. The strategies and their definitions are illustrated, using a hypothetical behavioral medicine intervention as an example, for each of the four levels of the implementation process. This UCD glossary may prove useful to implementation experts who wish to develop effective collaborations and "shared language" with UCD experts to enhance use of behavioral medicine research in health services. Directions for future research are also discussed.
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Affiliation(s)
- Alex R Dopp
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Kathryn E Parisi
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Sean A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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28
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Shelton RC, Lee M, Brotzman LE, Wolfenden L, Nathan N, Wainberg ML. What Is Dissemination and Implementation Science?: An Introduction and Opportunities to Advance Behavioral Medicine and Public Health Globally. Int J Behav Med 2020; 27:3-20. [PMID: 32060805 DOI: 10.1007/s12529-020-09848-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There has been a well-documented gap between research (e.g., evidence-based programs, interventions, practices, policies, guidelines) and practice (e.g., what is routinely delivered in real-world community and clinical settings). Dissemination and implementation (D&I) science has emerged to address this research-to-practice gap and accelerate the speed with which translation and real-world uptake and impact occur. In recent years, there has been tremendous development in the field and a growing global interest, but much of the introductory literature has been U.S.-centric. This piece provides an introduction to D&I science and summarizes key concepts and progress of the field for a global audience, provides two case studies that highlight examples of D&I research globally, and identifies opportunities and innovations for advancing the field of D&I research globally.
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29
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Burnham JP, Geng E, Venkatram C, Colditz GA, McKay VR. Putting the Dissemination and Implementation in Infectious Diseases. Clin Infect Dis 2020; 71:218-225. [PMID: 31608379 PMCID: PMC7312236 DOI: 10.1093/cid/ciz1011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Dissemination and implementation science seeks generalizable knowledge about closing the gap between clinical discovery and actual use in routine practice and public health. The field of infectious diseases enjoys an abundance of highly efficacious interventions (eg, antimicrobial agents, human immunodeficiency virus treatment) which are not adequately used in routine care, thereby missing critical opportunities to improve population health. In this article, we summarize salient features of dissemination and implementation science, reviewing definitions and methodologies for infectious diseases clinicians and researchers. We give examples of the limited use of dissemination and implementation science in infectious diseases thus far, suggest opportunities for application, and provide resources for interested readers to use and apply to their own research and practice.
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Affiliation(s)
- Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elvin Geng
- Division of Infectious Diseases, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri, USA
| | - Virginia R McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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30
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Hwang S, Birken SA, Melvin CL, Rohweder CL, Smith JD. Designs and methods for implementation research: Advancing the mission of the CTSA program. J Clin Transl Sci 2020; 4:159-167. [PMID: 32695483 PMCID: PMC7348037 DOI: 10.1017/cts.2020.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use. To address the challenge of translating evidence-based interventions (EBIs) into practice, the field of implementation science has emerged as a distinct discipline. With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology, shifting focus from clinical outcomes to the systems that support adoption and delivery of EBIs with fidelity. METHODS Implementation research designs share many of the foundational elements and assumptions of efficacy/effectiveness research. Designs and methods that are currently applied in implementation research include experimental, quasi-experimental, observational, hybrid effectiveness-implementation, simulation modeling, and configurational comparative methods. RESULTS Examples of specific research designs and methods illustrate their use in implementation science. We propose that the CTSA program takes advantage of the momentum of the field's capacity building in three ways: 1) integrate state-of-the-science implementation methods and designs into its existing body of research; 2) position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science; and 3) provide adequate training in implementation science. CONCLUSIONS As implementation methodologies mature, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise and shared infrastructures that aim to advance healthcare in the USA and around the world.
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Affiliation(s)
- Soohyun Hwang
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A. Birken
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cathy L. Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine L. Rohweder
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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31
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Hamilton AB, Finley EP. Reprint of: Qualitative methods in implementation research: An introduction. Psychiatry Res 2020; 283:112629. [PMID: 31735374 DOI: 10.1016/j.psychres.2019.112629] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/12/2023]
Abstract
Qualitative methods are a valuable tool in implementation research because they help to answer complex questions such as how and why efforts to implement best practices may succeed or fail, and how patients and providers experience and make decisions in care. This article orients the novice implementation scientist to fundamentals of qualitative methods and their application in implementation research, describing: 1) implementation-related questions that can be addressed by qualitative methods; 2) qualitative methods commonly used in implementation research; 3) basic sampling and data collection procedures; and 4) recommended practices for data analysis and ensuring rigor. To illustrate qualitative methods decision-making, a case example is provided of a study examining implementation of a primary care-based collaborative care management model for women Veterans with anxiety, depression, and PTSD.
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Affiliation(s)
- Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health San Antonio, San Antonio, TX, USA
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32
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Kemp CG, Wagenaar BH, Haroz EE. Expanding Hybrid Studies for Implementation Research: Intervention, Implementation Strategy, and Context. Front Public Health 2019; 7:325. [PMID: 31781528 PMCID: PMC6857476 DOI: 10.3389/fpubh.2019.00325] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Successful implementation reflects the interplay between intervention, implementation strategy, and context. Hybrid effectiveness-implementation studies allow investigators to assess the effects of both intervention and implementation strategy, though the role of context as a third independent variable (IV) is incompletely specified. Our objective is to expand the hybrid typology to include mixtures of all three types of IVs: intervention, implementation strategy, and context. We propose to use I to represent the IV of intervention, IS to represent implementation strategy, and C to represent context. Primary IVs are written first and in upper case. Secondary IVs are written after a forward slash and in lower case; co-primary IVs are written after a dash and in upper case. The expanded framework specifies nine two-variable hybrid types: I/is, I-IS, IS/i, IS/c, IS-C, C/is, C/i, I-C, and I/c. We describe four in detail: I/is, IS/c, IS-C, and C/is. We also specify seven three-variable hybrid types. We argue that many studies already meet our definitions of two- or three-variable hybrids. Our proposal builds from the typology proposed by Curran et al. (1), but offers a more complete specification of hybrid study types. We need studies that measure the implementation-related effects of variations in contextual determinants, both to advance the science and to optimize intervention delivery in the real world. Prototypical implementation studies that evaluate the effectiveness of an implementation strategy, in isolation from its context, risk perpetuating the gap between evidence and practice, as they will not generate context-specific knowledge around implementation, scale-up, and de-implementation.
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Affiliation(s)
- Christopher G Kemp
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Emily E Haroz
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States.,Center for American Indian Health, Johns Hopkins University, Baltimore, MD, United States
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33
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Abstract
Qualitative methods are a valuable tool in implementation research because they help to answer complex questions such as how and why efforts to implement best practices may succeed or fail, and how patients and providers experience and make decisions in care. This article orients the novice implementation scientist to fundamentals of qualitative methods and their application in implementation research, describing: 1) implementation-related questions that can be addressed by qualitative methods; 2) qualitative methods commonly used in implementation research; 3) basic sampling and data collection procedures; and 4) recommended practices for data analysis and ensuring rigor. To illustrate qualitative methods decision-making, a case example is provided of a study examining implementation of a primary care-based collaborative care management model for women Veterans with anxiety, depression, and PTSD.
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Affiliation(s)
- Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health San Antonio, San Antonio, TX, USA
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Sterling MR, Echeverria SE, Commodore-Mensah Y, Breland JY, Nunez-Smith M. Health Equity and Implementation Science in Heart, Lung, Blood, and Sleep-Related Research: Emerging Themes From the 2018 Saunders-Watkins Leadership Workshop. Circ Cardiovasc Qual Outcomes 2019; 12:e005586. [PMID: 31610713 PMCID: PMC6812546 DOI: 10.1161/circoutcomes.119.005586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Disparities in health outcomes for heart, lung, blood, and sleep-related health conditions are pervasive in the United States, with an unequal burden experienced among structurally disadvantaged populations. One reason for this disparity is that despite the existence of effective interventions that promote health equity, few have been translated and implemented consistently in the healthcare system. To achieve health equity, there is a dire need to implement and disseminate effective evidence-based interventions that account for the complex and multilayered social determinants of health among marginalized groups across healthcare settings. To that end, the National Heart, Lung, and Blood Institute's Center for Translation Research and Implementation Science invited early stage investigators to participate in the inaugural Saunders-Watkins Leadership Workshop in May of 2018 at the National Institutes of Health. The goals of the workshop were to: (1) present an overview of health equity research, including areas which require ongoing investigation; (2) review how the fields of health equity and implementation science are related; (3) demonstrate how implementation science could be utilized to advance health equity; and (4) foster early stage investigator career success in heart, lung, blood, and sleep-related research. Herein, we highlight key themes from the 2-day workshop and offer recommendations for the future direction of health equity and implementation science research in the context of heart, lung, blood, and sleep-related health conditions.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sandra E. Echeverria
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, NC
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Jessica Y Breland
- Center for Innovation to Implementation, Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT
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Baumann AA, Mejia A, Lachman JM, Parra Cardona JR, López-Zerón G, Amador Buenabad NG, Vargas E, Domenech Rodríguez MM. Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice. Glob Soc Welf 2019; 6:199-207. [PMID: 32095423 PMCID: PMC7036747 DOI: 10.1007/s40609-018-0121-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.
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Affiliation(s)
| | - Anilena Mejia
- Instituto de Investigaciones Científicas y Servicios de Alta
Tecnología (INDICASAT)
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Oluwoye O, Kriegel L, Alcover KC, McPherson S, McDonell MG, Roll JM. The dissemination and implementation of contingency management for substance use disorders: A systematic review. Psychol Addict Behav 2019; 34:99-110. [PMID: 31259569 DOI: 10.1037/adb0000487] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is one of the most effective behavioral interventions for substance use. However, the implementation of contingency management has not been as widespread as might be expected given its efficacy. This review summarizes literature that examines the dissemination and implementation of contingency management for substance use in community (e.g., specialized substance use treatment) and clinical (e.g., primary care) settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases including Google Scholar, World of Knowledge, PsycINFO, and PubMed were searched. Search results yielded 100 articles and after the screening of titles and abstracts 44 were identified. Full-text articles were examined for eligibility and yielded 24 articles that were included in this review. Of the 24 articles included in the review, the majority (n = 11) focused on implementing contingency management in methadone clinics and opioid treatment programs. Training methods, implementation strategies, fidelity assessments, and attitudes toward the implementation of contingency management are discussed in greater detail. These findings highlight the importance of organizational input and ongoing supervision and consultation, and the need for additional research that is guided by theoretical frameworks and use rigorous study designs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Karl C Alcover
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane
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Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM, Weiner BJ. Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Front Public Health 2019; 7:3. [PMID: 30723713 PMCID: PMC6350272 DOI: 10.3389/fpubh.2019.00003] [Citation(s) in RCA: 318] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/04/2019] [Indexed: 01/10/2023] Open
Abstract
The field of implementation science was developed to better understand the factors that facilitate or impede implementation and generate evidence for implementation strategies. In this article, we briefly review progress in implementation science, and suggest five priorities for enhancing the impact of implementation strategies. Specifically, we suggest the need to: (1) enhance methods for designing and tailoring implementation strategies; (2) specify and test mechanisms of change; (3) conduct more effectiveness research on discrete, multi-faceted, and tailored implementation strategies; (4) increase economic evaluations of implementation strategies; and (5) improve the tracking and reporting of implementation strategies. We believe that pursuing these priorities will advance implementation science by helping us to understand when, where, why, and how implementation strategies improve implementation effectiveness and subsequent health outcomes.
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Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Rinad S Beidas
- Department of Psychiatry, Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Cara C Lewis
- MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Bryan J Weiner
- Department of Global Health, Department of Health Services, University of Washington, Seattle, WA, United States
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Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci 2019; 14:1. [PMID: 30611302 PMCID: PMC6321673 DOI: 10.1186/s13012-018-0842-6] [Citation(s) in RCA: 459] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Methods A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale). Results In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5). Conclusion This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available. Electronic supplementary material The online version of this article (10.1186/s13012-018-0842-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Perth, 6102, Western Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.,Department of Child and Family Development, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive (0725), La Jolla, San Diego, CA, 92093-0812, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.
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Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, Zhang J, Musana O, Wanyonyi SZ, Gülmezoglu AM, Downe S. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392:1358-1368. [PMID: 30322586 DOI: 10.1016/s0140-6736(18)31927-5] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions. In this Series paper, we describe the factors for CS use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. We also outline the type and effects of interventions to reduce CS use that have been investigated. Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS, could reduce the frequency of CS use. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.
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Affiliation(s)
- Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Abdu Mohiddin
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Newton Opiyo
- Review Production and Quality Unit, Cochrane, London, UK
| | - Maria Regina Torloni
- Postgraduate Program on Evidence-Based Healthcare, São Paulo Federal University, São Paulo, Brazil
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Othiniel Musana
- Uganda Martyrs University, St Francis Hospital Nsambya, Kampala, Uganda
| | - Sikolia Z Wanyonyi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Ahmet Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Uc A, Andersen DK, Borowitz D, Glesby MJ, Mayerle J, Sutton R, Pandol SJ. Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis-Knowledge Gaps and Research Opportunities: Overview Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2018; 47:1180-4. [PMID: 30325855 DOI: 10.1097/MPA.0000000000001176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A workshop was sponsored by the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, on July 25, 2018, in Pittsburgh, Penn. The workshop was designed to bring together a multidisciplinary group of experts to accelerate the development of therapeutics for clinical application in inflammatory diseases of the exocrine pancreas. Three separate working groups (acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis) were formed to address the needs, gaps, and opportunities. The working groups included patients with pancreatic diseases, pharmaceutical company leaders, basic scientists, clinical researchers, and representatives from the US Food and Drug Administration to assist with regulatory considerations and to identify the unmet needs, research targets, and opportunities to provide direction for successful development of therapeutic agents in these diseases. This article represents the summary of the overview presentations at the National Institute of Diabetes and Digestive and Kidney Diseases workshop including an ongoing drug trial in acute pancreatitis; a successful drug development network developed by the Cystic Fibrosis Foundation; and considerations for subject selection in drug trials, incorporating Food and Drug Administration guidelines on clinical trial design and clinical outcome measures. The summaries of each working group follow separately in accompanying articles.
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