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Gogovor A, Zomahoun HTV, Ben Charif A, Ekanmian G, Moher D, McLean RKD, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Rheault N, Légaré F. Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review. Medicine (Baltimore) 2024; 103:e37079. [PMID: 38363902 PMCID: PMC10869056 DOI: 10.1097/md.0000000000037079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
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Affiliation(s)
- Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | | | | | - Giraud Ekanmian
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Robert K. D. McLean
- International Development Research Centre, Ottawa, ON
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, ON
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, NSW
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
- The National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW
| | | | | | - Paula Rochon
- Women’s Age Lab, Women’s College Hospital, Toronto, ON
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - France Légaré
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
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Légaré F, G V Mochcovitch D, de Carvalho Corôa R, Gogovor A, Ben Charif A, Cameron C, Plamondon A, Cimon M, Guay-Bélanger S, Roch G, Dumas Pilon M, Paquette JS, McLean RKD, Milat A. Spontaneous Scaling of a Primary Care Innovation in Real-Life Conditions: Protocol for a Case Study. JMIR Res Protoc 2023; 12:e54855. [PMID: 38032757 PMCID: PMC10784976 DOI: 10.2196/54855] [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: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Scaling effective primary care innovations to benefit more people is of interest to decision makers. However, we know little about how promising innovations are being scaled "spontaneously," that is, without deliberate guidance. OBJECTIVE We aim to observe, document, and analyze how, in real-life conditions, 1 primary care innovation spontaneously scales up across Quebec, Canada. METHODS We will conduct a participative study using a descriptive single-case study. It will be guided by the McLean and Gargani principles for scaling and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Informed by an integrated knowledge translation approach, our steering committee will include patient users throughout the project. Inspired by the Quebec College of Family Physician's "Dragons' Den" primary care program, we will identify a promising primary care innovation that is being or will be scaled spontaneously. We will interview the innovation team about their scaling experiences every month for 1 year. We will conduct interviews and focus groups with decision makers, health care providers, and end users in the innovation team and the target site about their experience of both scaling and receiving the scaled innovation and document meetings as nonparticipant observers. Interview transcripts and documentary data will be analyzed to (1) compare the spontaneous scaling plan and implementation with the McLean and Gargani principles for scaling and (2) determine how it was consistent with or diverged from the 4 McLean and Gargani guiding principles: justification, optimal scale, coordination, and dynamic evaluation. RESULTS This study was funded in March 2020 by the Canadian Institutes of Health Research. Recruitment began in November 2023 and data collection began in December 2023. Results are expected to be published in the first quarter of 2024. CONCLUSIONS Our study will advance the science of scaling by providing practical evidence-based material about scaling health and social care innovations in real-world settings using the 4 guiding principles of McLean and Gargani. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54855.
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Affiliation(s)
- France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de Recherche du CHU de Québec - Université Laval, CHU de Québec, Quebec, QC, Canada
| | - Diogo G V Mochcovitch
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Roberta de Carvalho Corôa
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Amédé Gogovor
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | | | - Cynthia Cameron
- Groupe de Médecine de Famille Universitaire de Lévis, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Annie Plamondon
- Faculty of Social Sciences, Université Laval, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Geneviève Roch
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de Recherche du CHU de Québec - Université Laval, CHU de Québec, Quebec, QC, Canada
- Groupe de Médecine de Famille Universitaire de Lévis, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Maxine Dumas Pilon
- Indigo Clinic, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Quebec College of Family Physicians, Montreal, QC, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | | | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Guay-Bélanger S, Aubin E, Cimon M, Archambault P, Blanchette V, Giguere A, Gogovor A, Morin M, Ben Charif A, Ben Gaied N, Bickerstaff J, Chénard N, Emond J, Gilbert J, Violet I, Légaré F. Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care. JMIR Res Protoc 2023; 12:e53150. [PMID: 37889512 PMCID: PMC10696497 DOI: 10.2196/53150] [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: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. OBJECTIVE This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. METHODS This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. RESULTS This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. CONCLUSIONS This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53150.
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Affiliation(s)
- Sabrina Guay-Bélanger
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Emmanuelle Aubin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anik Giguere
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Michèle Morin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | | | | | - Nancy Chénard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Emond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Gilbert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Isabelle Violet
- Ministère de la santé et des services sociaux du Québec, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Sivakumar A, Pan RY, Wang A, Choi D, Charif AB, Kastner M, Légaré F, Yu CH. Assessing the sustainability and scalability of a diabetes eHealth innovation: a mixed-methods study. BMC Health Serv Res 2023; 23:630. [PMID: 37316850 DOI: 10.1186/s12913-023-09618-x] [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: 11/14/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND To date, little is known about the sustainability and scalability of MyDiabetesPlan, an eHealth innovation designed to facilitate shared decision-making within diabetes care. To avoid the possibility of its short-lived implementation and promote wider adoption so as to promote patient-centred diabetes care, it is critical to understand MyDiabetesPlan's sustainability and scalability in order to ensure its long-term impact at a greater scale. We sought to identify the sustainability and scalability potential of MyDiabetesPlan and its limiting factors. METHODS Using a concurrent triangulation mixed-methods approach, data were collected from 20 individuals involved in the development and implementation of MyDiabetesPlan. The National Health Services Sustainability Model (NHSSM) and the Innovation Scalability Self-administered Questionnaire (ISSaQ) were administered using a 'think-aloud' approach and subsequently, short semi-structured interviews were conducted. Mean aggregate scores and stakeholder-specific scores were generated for the NHSSM and ISSaQ, to quantitatively determine facilitating and limiting factors to sustainability and scalability. Content analysis occurred iteratively with qualitative data, to examine commonalities and differences with the quantitative findings. RESULTS The top facilitating factor to sustaining MyDiabetesPlan was "Staff involvement and training to sustain the process.", whereas the top limiting factors were: "Adaptability of Improved Process", "Senior Leadership Engagement" and "Infrastructure for Sustainability". The top three facilitating factors for scale-up were "Acceptability", "Development with Theory" and "Consistency with Policy Directives." Conversely, the top three limiting factors were "Financial and Human Resources", "Achievable Adoption" and "Broad Reach". Qualitative findings corroborated the limiting/facilitating factors identified. CONCLUSIONS Addressing staff involvement throughout the dynamic care contexts, and resource constraints impacting scale-up can enhance the sustainability and scalability of MyDiabetesPlan. As such, future plans will focus on garnering organizational leadership buy-in and support, which may address the resource constraints associated with sustainability and scalability and improve the capacity for adequate staff involvement. eHealth researchers will be able to prioritize these limiting factors from the outset of their tool development to purposefully optimize its sustainability and scalability performance.
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Affiliation(s)
- Arani Sivakumar
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Rachel Y Pan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Angel Wang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Ali Ben Charif
- VITAM - Centre de Recherche en Santé Durable, Université Laval, Quebec City, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - France Légaré
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University (Québec), Québec City, G1K 7P4, Canada
| | - Catherine H Yu
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology & Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Karamagi HC, Ben Charif A, Afriyie DO, Sy S, Kipruto H, Oyelade T, Droti B. Mapping health service coverage inequalities in Africa: a scoping review protocol. BMJ Open 2023; 13:e068903. [PMID: 37253504 PMCID: PMC10255155 DOI: 10.1136/bmjopen-2022-068903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/11/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Addressing inequities in health service coverage is a global priority, especially with the resurgence of interest in universal health coverage. However, in Africa, which has the lowest health service coverage index, there is limited information on the progress of countries in addressing inequalities related to health services. Thus, we seek to map the evidence on inequalities in health service coverage in Africa. METHODS AND ANALYSIS We will conduct a scoping review following the Joanna Briggs Institute Manual for Evidence Synthesis. We preregistered this protocol with the Open Science Framework on 26 July 2022 (https://osf.io/zd5bt). We will consider any empirical research that assesses inequalities in relation to services for reproductive, maternal, newborn and child health (eg, family planning), infectious diseases (eg, tuberculosis treatment) and non-communicable diseases (eg, cervical cancer screening) in Africa. We will search MEDLINE, Embase, Web of Science, CINAHL, PsycINFO and Cochrane Library from their inception onwards. We will also hand-search Google and Global Index Medicus, and screen reference lists of relevant studies. We will evaluate studies for eligibility and extract data from included studies using pre-piloted and standardised forms. We will further extract a core set of health service coverage indicators, which are disaggregated by place of residence, race/ethnicity/culture, occupation, gender, religion, education, socioeconomic status and social capital plus equity stratifiers. We will summarise data using a narrative approach involving thematic syntheses and descriptive statistics. We will report our findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION Ethical approval is not required as primary data will not be collected. This work will contribute to identifying knowledge gaps in the evidence of inequalities in health service coverage in Africa, and propose strategies that could help overcome current challenges. We will disseminate our findings to knowledge users through a publication in a peer-reviewed journal and organisation of workshops.
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Affiliation(s)
| | | | - Doris Osei Afriyie
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Sokona Sy
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Hillary Kipruto
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Taiwo Oyelade
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benson Droti
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
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Poitras ME, Couturier Y, Doucet E, T. Vaillancourt V, Poirier MD, Gauthier G, Hudon C, Delli-Colli N, Gagnon D, Careau E, Duhoux A, Gaboury I, Charif AB, Ashcroft R, Lukewich J, Ramond-Roquin A, Massé S. Co-design, implementation, and evaluation of an expanded train-the-trainer strategy to support the sustainability of evidence-based practice guides for registered nurses and social workers in primary care clinics: a developmental evaluation protocol. BMC Prim Care 2022; 23:84. [PMID: 35436845 PMCID: PMC9016936 DOI: 10.1186/s12875-022-01684-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
Background The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project’s goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. Methods/design This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. Discussion This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.
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Toi AK, Ben Charif A, Lai C, Ngueta G, Plourde KV, Stacey D, Légaré F. Difficult Decisions for Older Canadians Receiving Home Care, and Why They Are So Difficult: A Web-Based Decisional Needs Assessment. MDM Policy Pract 2022; 7:23814683221124090. [PMID: 36132436 PMCID: PMC9483974 DOI: 10.1177/23814683221124090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/01/2022] [Indexed: 12/01/2022] Open
Abstract
Background. Older adults receiving home care services often face
decisions related to aging, illness, and loss of autonomy. To inform tailored
shared decision making interventions, we assessed their decisional needs by
asking about the most common difficult decisions, measured associated decisional
conflict, and identified factors associated with it. Methods. In
March 2020, we conducted a cross-sectional survey with a pan-Canadian Web-based
panel of older adults (≥65 y) receiving home care services. For a difficult
decision they had faced in the past year, we evaluated clinically significant
decisional conflict (CSDC) using the 16-item Decisional Conflict Scale (score
0–100) with a >37.5 cutoff. To identify factors associated with CSDC, we
performed descriptive, bivariable, and multivariable analyses using the stepwise
selection method with an assumed entry and exit significance level of 0.15 and
0.20, respectively. Final model selection was based on the Bayesian information
criterion. Results. Among 460 participants with an average age of
72.5 y, difficult decisions were, in order of frequency, about housing and
safety (57.2%), managing health conditions (21.8%), and end-of-life care (8.3%).
CSDC was experienced by 14.6% (95% confidence interval [CI]: 11.5%, 18.1%) of
respondents on all decision points. Factors associated with CSDC included
household size = 1 (OR [95% CI]: 1.81 [0.99, 3.33]; P = 0.27),
household size = 3 (2.66 [0.78, 8.98]; P = 0.83), and household
size = 4 (6.91 [2.23, 21.39]; P = 0.014); preferred option not
matching the decision made (4.05 [2.05, 7.97]; P < 0.001);
passive role in decision making (5.13 [1.78, 14.77]; P =
0.002); and lower quality of life (0.70 [0.57, 0.87];
P<0.001). Discussion. Some older adults
receiving home care services in Canada experience CSDC when facing difficult
decisions. Shared decision-making interventions could mitigate associated
factors.
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Affiliation(s)
- Alfred Kodjo Toi
- VITAM–Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Ali Ben Charif
- VITAM–Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Gérard Ngueta
- VITAM–Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Karine V. Plourde
- VITAM–Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Patient Decision Aids Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - France Légaré
- VITAM–Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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8
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Uwizeye CB, Zomahoun HTV, Bussières A, Thomas A, Kairy D, Massougbodji J, Rheault N, Tchoubi S, Philibert L, Abib Gaye S, Khadraoui L, Ben Charif A, Diendéré E, Langlois L, Dugas M, Légaré F. Implementation strategies for knowledge products in primary healthcare: a systematic review of systematic reviews (Preprint). Interact J Med Res 2022; 11:e38419. [PMID: 35635786 PMCID: PMC9315889 DOI: 10.2196/38419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.
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Affiliation(s)
- Claude Bernard Uwizeye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Dahlia Kairy
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, QC, Canada
| | - José Massougbodji
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Nathalie Rheault
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Sébastien Tchoubi
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
| | - Leonel Philibert
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Faculty of Nursing, Laval University, Québec, QC, Canada
| | - Serigne Abib Gaye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
| | - Lobna Khadraoui
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Ali Ben Charif
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada
- CubecXpert, Québec, QC, Canada
| | - Ella Diendéré
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Léa Langlois
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - France Légaré
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
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9
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Ben Charif A, Zomahoun HTV, Gogovor A, Abdoulaye Samri M, Massougbodji J, Wolfenden L, Ploeg J, Zwarenstein M, Milat AJ, Rheault N, Ousseine YM, Salerno J, Markle-Reid M, Légaré F. Tools for assessing the scalability of innovations in health: a systematic review. Health Res Policy Syst 2022; 20:34. [PMID: 35331260 PMCID: PMC8943495 DOI: 10.1186/s12961-022-00830-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 05/26/2021] [Accepted: 02/16/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The last decade has seen growing interest in scaling up of innovations to strengthen healthcare systems. However, the lack of appropriate methods for determining their potential for scale-up is an unfortunate global handicap. Thus, we aimed to review tools proposed for assessing the scalability of innovations in health. METHODS We conducted a systematic review following the COSMIN methodology. We included any empirical research which aimed to investigate the creation, validation or interpretability of a scalability assessment tool in health. We searched Embase, MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and ERIC from their inception to 20 March 2019. We also searched relevant websites, screened the reference lists of relevant reports and consulted experts in the field. Two reviewers independently selected and extracted eligible reports and assessed the methodological quality of tools. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. RESULTS We identified 31 reports describing 21 tools. Types of tools included criteria (47.6%), scales (33.3%) and checklists (19.0%). Most tools were published from 2010 onwards (90.5%), in open-access sources (85.7%) and funded by governmental or nongovernmental organizations (76.2%). All tools were in English; four were translated into French or Spanish (19.0%). Tool creation involved single (23.8%) or multiple (19.0%) types of stakeholders, or stakeholder involvement was not reported (57.1%). No studies reported involving patients or the public, or reported the sex of tool creators. Tools were created for use in high-income countries (28.6%), low- or middle-income countries (19.0%), or both (9.5%), or for transferring innovations from low- or middle-income countries to high-income countries (4.8%). Healthcare levels included public or population health (47.6%), primary healthcare (33.3%) and home care (4.8%). Most tools provided limited information on content validity (85.7%), and none reported on other measurement properties. The methodological quality of tools was deemed inadequate (61.9%) or doubtful (38.1%). CONCLUSIONS We inventoried tools for assessing the scalability of innovations in health. Existing tools are as yet of limited utility for assessing scalability in health. More work needs to be done to establish key psychometric properties of these tools. Trial registration We registered this review with PROSPERO (identifier: CRD42019107095).
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Affiliation(s)
| | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine and Health Science, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | - Mamane Abdoulaye Samri
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - José Massougbodji
- Institut national de santé publique du Québec (INSPQ), Quebec City, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | | | - Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Canada Research Chair in Person Centred Interventions for Older Adults with Multimorbidity and their Caregivers, McMaster University, Hamilton, ON, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada.
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10
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Karamagi HC, Ben Charif A, Ngusbrhan Kidane S, Yohanes T, Kariuki D, Titus M, Batungwanayo C, Seydi ABW, Berhane A, Nzinga J, Njuguna D, Kipruto HK, Andrews Annan E, Droti B. Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review. PLOS Glob Public Health 2022; 2:e0001076. [PMID: 36962623 PMCID: PMC10021830 DOI: 10.1371/journal.pgph.0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Tewelde Yohanes
- Division of Policy and Planning, Ministry of Health, Asmara, Eritrea
| | | | | | | | - Aminata Binetou-Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Njuguna
- Health Economist, Ministry of Health, Nairobi, Kenya
| | - Hillary Kipchumba Kipruto
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Edith Andrews Annan
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benson Droti
- Health Information Systems, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Congo
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11
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Légaré F, Plourde KV, Charif AB, Gogovor A, Brundisini FK, McLean RKD, Milat A, Rheault N, Wolfenden L, Zomahoun HTV. Evidence on scaling in health and social care: protocol for a living umbrella review. Syst Rev 2021; 10:261. [PMID: 34593027 PMCID: PMC8485425 DOI: 10.1186/s13643-021-01813-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing interest in scaling effective health innovations to promote equitable access to high-quality health services worldwide. However, multiple challenges persist in scaling innovations. In this study, we aim to summarize the scaling evidence in the health and social care literature and identify current knowledge gaps. METHODS We will conduct a living umbrella review according to the Joanna Briggs Institute Reviewers' Manual. We will consider all knowledge syntheses addressing scaling in health or social care (e.g., any setting, any clinical area) and conducted in a systematic way. We will search the following electronic databases: MEDLINE (Ovid), Embase, PsychINFO (Ovid), CINAHL (EBSCO), Web of Science, The Cochrane Library, Sociological Abstract (Proquest), Academic Search Premier (EBSCO), and Proquest Dissertations & Theses Global, from inception. Furthermore, we will conduct searches of the grey literature. No restriction regarding date or language will be applied. Each phase of the review will be processed by two independent reviewers. We will develop a data extraction form on Covidence. We will assess the methodological quality of the included reviews using AMSTAR2 and the risk of bias using ROBIS. Results will be presented in tabular form and accompanied by a narrative synthesis covering the traditional themes of scaling science that emerge from the analysis, such as coverage, range, and sustainability, as well as themes less covered in the literature, including reporting guidance, models, tools, barriers, and/or facilitators to scaling innovations, evidence regarding application in high-income or low-income countries, and end-user engagement. We will disseminate the findings via publications and through relevant networks. DISCUSSION The findings of the umbrella review will facilitate access to scaling evidence in the literature and help strengthen the science of scaling for researchers, policy makers, and program managers. Finally, this work will highlight important knowledge gaps and help prioritize future research questions. SYSTEMATIC REVIEW REGISTRATION This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on November 11, 2020 (registration number: CRD42020183774 ).
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Affiliation(s)
- France Légaré
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada. .,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
| | - Karine V Plourde
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Ali Ben Charif
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Francesca Katherine Brundisini
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Robert K D McLean
- International Development Research Centre, Ottawa, ON, Canada.,Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Hervé Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
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12
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Ben Charif A, Plourde KV, Guay-Bélanger S, Zomahoun HTV, Gogovor A, Straus S, Beleno R, Kastner K, McLean RKD, Milat AJ, Wolfenden L, Paquette JS, Geiger F, Légaré F. Strategies for involving patients and the public in scaling-up initiatives in health and social services: protocol for a scoping review and Delphi survey. Syst Rev 2021; 10:55. [PMID: 33573701 PMCID: PMC7877693 DOI: 10.1186/s13643-021-01597-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/20/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS. METHODS We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: (1) participants-any stakeholder involved in creating or testing a strategy for PPI; (2) intervention-any PPI strategy proposed for scaling-up initiatives; (3) comparator-no restriction; (4) outcomes: any process or outcome metrics related to PPI; and (5) setting-HSS. We will search electronic databases (e.g., Medline, Web of Science, Sociological Abstract) from inception onwards, hand search relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities. DISCUSSION Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS. SYSTEMATIC REVIEW REGISTRATION We registered this protocol with the Open Science Framework on August 19, 2020 ( https://osf.io/zqpx7/ ).
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Affiliation(s)
- Ali Ben Charif
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Karine V Plourde
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada
| | - Sabrina Guay-Bélanger
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine, School of Physical and Occupational Therapy, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Amédé Gogovor
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec City, QC, Canada
| | - Sharon Straus
- LiKaShing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ron Beleno
- Age-Well NCE, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | - Robert K D McLean
- International Development Research Centre, Ottawa, ON, Canada.,Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jean-Sébastien Paquette
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Laboratoire ARIMED, Groupe de médecine de famille universitaire (GMF-U) de Saint-Charles-Borromée, Saint-Charles-Borromée, QC, Canada
| | - Friedemann Geiger
- SHARE TO CARE Project, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Department of Pediatrics, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Institute for Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada. .,Diabetes Action Canada, a SPOR Network in Diabetes and its Related Complications, Université Laval, Quebec City, QC, Canada.
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13
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Seguin L, Touzani R, Bouhnik AD, Charif AB, Marino P, Bendiane MK, Gonçalves A, Gravis G, Mancini J. Deterioration of Sexual Health in Cancer Survivors Five Years after Diagnosis: Data from the French National Prospective VICAN Survey. Cancers (Basel) 2020; 12:cancers12113453. [PMID: 33233583 PMCID: PMC7699784 DOI: 10.3390/cancers12113453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Little is known about cancer survivors' sexual health (SH)-particularly, from well after diagnosis and in cancers unrelated to sexuality. This study aimed to assess SH deterioration five years after diagnosis. We analyzed data from the French national VIe après le CANcer (VICAN) survey. Six items from the Relationship and Sexuality Scale were used to assess SH. Respondents were grouped according to an ascending hierarchical classification in four clusters: strong, moderate, and weak deterioration or stable (WD, SD, MD, or St). Out of 2195 eligible participants, 57.3% reported substantial SH deterioration as either SD (30.8%) or MD (26.5%), while WD and St accounted for 31.2% and 11.5% of respondents, respectively. Substantial deterioration was reported in all cancer sites (from 27.7% in melanoma to 83.1% in prostate). Treatment type, cancer sequelae, and pain, as well as psychological consequences (depression and anxiety, especially for younger patients) were associated with substantial SH deterioration. The same factors were identified after restricting the analysis to survivors of cancers unrelated to sexuality. Five years after diagnosis, the majority of cancer survivors reported SH deterioration. Interventions should be developed to improve SH regardless of cancer site. Particular attention should be paid to depression and anxiety, especially in younger survivors.
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Affiliation(s)
- Lorène Seguin
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Correspondence: ; Tel.: +33-(0)491-223-502
| | - Ali Ben Charif
- VITAM—Centre de recherche en santé durable Quebec, Quebec, QC G1J0A4, Canada;
| | - Patricia Marino
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Aix Marseille Univ, 13005 Marseille, France;
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14
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Elidor H, Adekpedjou R, Zomahoun HTV, Ben Charif A, Agbadjé TT, Rheault N, Légaré F. Extent and Predictors of Decision Regret among Informal Caregivers Making Decisions for a Loved One: A Systematic Review. Med Decis Making 2020; 40:946-958. [PMID: 33089748 PMCID: PMC7672779 DOI: 10.1177/0272989x20963038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/30/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Informal caregivers often serve as decision makers for dependent or vulnerable individuals facing health care decisions. Decision regret is one of the most prevalent outcomes reported by informal caregivers who have made such decisions. OBJECTIVE To examine levels of decision regret and its predictors among informal caregivers who have made health-related decisions for a loved one. DATA SOURCES We performed a systematic search of Embase, MEDLINE, Web of Science, and Google Scholar up to November 2018. Participants were informal caregivers, and the outcome was decision regret as measured using the Decision Regret Scale (DRS). REVIEW METHODS Two reviewers independently selected eligible studies, extracted data, and assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. We performed a narrative synthesis and presented predictors of decision regret using a conceptual framework, dividing the predictors into decision antecedents, decision-making process, and decision outcomes. RESULTS We included 16 of 3003 studies identified. Most studies (n = 13) reported a mean DRS score ranging from 7.0 to 32.3 out of 100 (median = 14.3). The methodological quality of studies was acceptable. We organized predictors and their estimated effects (β) or odds ratio (OR) with 95% confidence interval (CI) as follows: decision antecedents (e.g., caregivers' desire to avoid the decision, OR 2.07, 95% CI [1.04-4.12], P = 0.04), decision-making process (e.g., caregivers' perception of effective decision making, β = 0.49 [0.05, 0.93], P < 0.01), and decision outcomes (e.g., incontinence, OR = 4.4 [1.1, 18.1], P < 0.001). CONCLUSIONS This review shows that informal caregivers' level of decision regret is generally low but is high for some decisions. We also identified predictors of regret during different stages of the decision-making process. These findings may guide future research on improving caregivers' experiences.
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Affiliation(s)
- Hélène Elidor
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Ali Ben Charif
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Titilayo Tatiana Agbadjé
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Nathalie Rheault
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - France Légaré
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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15
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Ben Charif A, Zomahoun HTV, Massougbodji J, Khadhraoui L, Pilon MD, Boulanger E, Gogovor A, Campbell MJ, Poitras MÈ, Légaré F. Assessing the scalability of innovations in primary care: a cross-sectional study. CMAJ Open 2020; 8:E613-E618. [PMID: 33011682 PMCID: PMC7567510 DOI: 10.9778/cmajo.20200030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Canadian health funding currently prioritizes scaling up for evidence-based primary care innovations, but not all teams prepare for scaling up. We explored scalability assessment among primary care innovators in the province of Quebec to evaluate their preparedness for scaling up. METHODS We performed a cross-sectional survey from Feb. 18 to Mar. 18, 2019. Eligible participants were 33 innovation teams selected for the 2019 Quebec College of Family Physicians' Symposium on Innovations. We conducted a Web-based survey in 2 sections: innovation characteristics and the Innovation Scalability Self-administered Questionnaire. The latter includes 16 criteria (scalability components) grouped into 5 dimensions: theory (1 criterion), impact (6 criteria), coverage (4 criteria), setting (3 criteria) and cost (2 criteria). We classified innovation types using the International Classification of Health Interventions. We performed a descriptive analysis using frequency counts and percentages. RESULTS Out of 33 teams, 24 participated (72.7%), with 1 innovation each. The types of innovation were management (15/24), prevention (8/24) and therapeutic (1/24). Most management innovations focused on patient navigation (9/15). In order of frequency, teams had assessed theory (79.2%) and impact (79.2%) criteria, followed by cost (77.1%), setting (59.7%) and coverage (54.2%). Most innovations (16/24) had assessed 10 criteria or more, including 10 management innovations, 5 prevention innovations and 1 therapeutic innovation. Implementation fidelity was the least assessed criterion (6/24). INTERPRETATION The scalability assessments of a primary care innovation varied according to its type. Management innovations, which were the most prevalent and assessed the most scalability components, appear to be most prepared for primary care scale-up in Canada.
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Affiliation(s)
- Ali Ben Charif
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Hervé Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - José Massougbodji
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Lobna Khadhraoui
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Maxine Dumas Pilon
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Elise Boulanger
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Marie-Josée Campbell
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - Marie-Ève Poitras
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que
| | - France Légaré
- VITAM - Centre de recherche en santé durable (Ben Charif, Zomahoun, Massougbodji, Khadhraoui, Gogovor, Légaré), Québec, Que.; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Gogovor, Légaré), Université Laval; Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit (Zomahoun, Massougbodji, Khadhraoui, Gogovor), Université Laval; Collège québécois des médecins de famille (Dumas Pilon, Boulanger, Campbell), Laval, Que.; Department of Family Medicine and Emergency Medicine (Poitras), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; Department of Family Medicine (Dumas Pilon) and School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences (Zomahoun), McGill University, Montréal, Que.
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16
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Elidor H, Ben Charif A, Djade CD, Adekpedjou R, Légaré F. Decision Regret among Informal Caregivers Making Housing Decisions for Older Adults with Cognitive Impairment: A Cross-sectional Analysis. Med Decis Making 2020; 40:416-427. [PMID: 32522090 DOI: 10.1177/0272989x20925368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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
Background. Informal caregivers are regularly faced with difficult housing decisions for older adults with cognitive impairment. They often regret the decision they made. We aimed to identify factors associated with decision regret among informal caregivers engaging in housing decisions for cognitively impaired older adults. Methods. We performed a secondary analysis of cross-sectional data collected from a cluster-randomized trial. Eligible participants were informal caregivers involved in making housing decisions for cognitively impaired older adults. Decision regret was assessed after caregivers' enrollment in the study using the Decision Regret Scale (DRS), scored from 0 to 100. We used a conceptual framework of potential predictors of regret to identify independent variables. We performed multilevel analyses using a mixed linear model by estimating fixed effects (β) and 95% confidence intervals (CIs). Results. The mean (SD) DRS score of 296 informal caregivers (mean [SD] age, 62 [12] years) was 12.4 (18.4). Factors associated with less decision regret were having a college degree compared to primary education (β [95% CI]: -11.14 [-18.36, -3.92]), being married compared to being single (-5.60 [-10.05, -1.15]), informal caregivers' perception that a joint process occurred (-0.14 [-0.25, -0.02]), and older adults' not having a specific housing preference compared to preferring to stay at home (-4.13 [-7.40, -0.86]). Factors associated with more decision regret were being retired compared to being a homemaker (7.74 [1.32, 14.16]), higher burden of care (0.14 [0.05, 0.22]), and higher decisional conflict (0.51 [0.34, 0.67]). Limitations. Our analysis may not illustrate all predictors of decision regret among informal caregivers. Conclusions. Our findings will allow risk-mitigation strategies for informal caregivers at risk of experiencing regret.
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Affiliation(s)
- Hélène Elidor
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Ali Ben Charif
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Codjo Djignefa Djade
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Zomahoun HTV, Massougbodji J, Bussières A, Thomas A, Kairy D, Uwizeye CB, Rheault N, Charif AB, Diendéré E, Langlois L, Tchoubi S, Gaye SA, Légaré F. Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews. Syst Rev 2020; 9:112. [PMID: 32430005 PMCID: PMC7236932 DOI: 10.1186/s13643-020-01382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The literature on the implementation of knowledge products is extensive. However, this literature is still difficult to interpret for policymakers and other stakeholders when faced with choosing implementation strategies likely to bring about successful change in their health systems. This work has the particularity to examine the scope of this literature, and to clarify the effectiveness of implementation strategies for different knowledge products. Consequently, we aim to (1) determine the strengths and weaknesses of existing literature overviews; (2) produce a detailed portrait of the literature on implementation strategies for various knowledge products; and (3) assess the effectiveness of implementation strategies for each knowledge product identified and classify them. METHODS We will use a three-phase approach consisting of a critical analysis of existing literature overviews, a systematic review of systematic reviews, and a series of systematic reviews and meta-analyses. We will follow the Cochrane Methodology for each of the three phases. Our eligibility criteria are defined following a PICOS approach: Population, individuals or stakeholders participating in healthcare delivery, specifically, healthcare providers, caregivers, and end users; Intervention, any type of strategy aiming to implement a knowledge product including, but not limited to, a decision support tool, a clinical practice guideline, a policy brief, or a decision-making tool, a one-pager, or a health intervention; Comparison, any comparator will be considered; Outcomes, phases 1 and 2-any outcome related to implementation strategies including, but not limited to, the measures of adherence/fidelity to the use of knowledge products, their acceptability, adoption, appropriateness, feasibility, adaptability, implementation costs, penetration/reach and sustainability; phase 3-any additional outcome related to patients (psychosocial, health behavioral, and clinical outcomes) or healthcare professionals (behavioral and performance outcomes); Setting, primary healthcare has to be covered. We will search MEDLINE (Ovid), EMBASE, Web of Science, PsycINFO, CINAHL, and the Cochrane Library from their inception onwards. For each phase, two reviewers will independently perform the selection of studies, data extraction, and assess their methodological quality. We will analyze extracted data, and perform narrative syntheses, and meta-analyses when possible. DISCUSSION Our results could inform not only the overviews' methodology but also the development of an online platform for the implementation strategies of knowledge products. This platform could be useful for stakeholders in implementation science. SYSTEMATIC REVIEW REGISTRATION Protocol registered on Open Science Framework, https://osf.io/eb8w2/.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Quebec, Canada
| | - José Massougbodji
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Quebec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada.,Réseau provincial de recherche en adaptation-réadaptation (REPAR), Montreal, Quebec, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada.,Réseau provincial de recherche en adaptation-réadaptation (REPAR), Montreal, Quebec, Canada
| | - Dahlia Kairy
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada.,Réseau provincial de recherche en adaptation-réadaptation (REPAR), Montreal, Quebec, Canada.,School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Claude Bernard Uwizeye
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada
| | - Nathalie Rheault
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
| | - Ella Diendéré
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, Quebec, Canada
| | - Léa Langlois
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada
| | - Sébastien Tchoubi
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada
| | - Serigne Abib Gaye
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Quebec, Quebec, Canada. .,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, Québec, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525, Chemin de la Canardière, Québec, G1J 0A4, Canada. .,Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, Quebec, Canada. .,Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada.
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Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action 2020; 12:1670449. [PMID: 31575331 PMCID: PMC6781190 DOI: 10.1080/16549716.2019.1670449] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Indexed: 12/03/2022] Open
Abstract
Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - Mirjam Marjolein Garvelink
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre , Quebec , QC , Canada
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Gogovor A, Zomahoun HTV, Ben Charif A, McLean RKD, Moher D, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Ekanmian G, Sawadogo J, Rheault N, Légaré F. Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process. Syst Rev 2020; 9:11. [PMID: 31926555 PMCID: PMC6954577 DOI: 10.1186/s13643-019-1258-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lack of a reporting guideline for scaling of evidence-based practices (EBPs) studies has prompted the registration of the Standards for reporting studies assessing the impact of scaling strategies of EBPs (SUCCEED) with EQUATOR Network. The development of SUCCEED will be guided by the following main steps recommended for developing health research reporting guidelines. METHODS Executive Committee. We established a committee composed of members of the core research team and of an advisory group. Systematic review. The protocol was registered with the Open Science Framework on 29 November 2019 (https://osf.io/vcwfx/). We will include reporting guidelines or other reports that may include items relevant to studies assessing the impact of scaling strategies. We will search the following electronic databases: EMBASE, PsycINFO, Cochrane Library, CINAHL, Web of Science, from inception. In addition, we will systematically search websites of EQUATOR and other relevant organizations. Experts in the field of reporting guidelines will also be contacted. Study selection and data extraction will be conducted independently by two reviewers. A narrative analysis will be conducted to compile a list of items for the Delphi exercise. CONSENSUS PROCESS We will invite panelists with expertise in: development of relevant reporting guidelines, methodologists, content experts, patient/member of the public, implementers, journal editors, and funders. We anticipated that three rounds of web-based Delphi consensus will be needed for an acceptable degree of agreement. We will use a 9-point scale (1 = extremely irrelevant to 9 = extremely relevant). Participants' response will be categorized as irrelevant (1-3), equivocal (4-6) and relevant (7-9). For each item, the consensus is reached if at least 80% of the participants' votes fall within the same category. The list of items from the final round will be discussed at face-to-face consensus meeting. Guideline validation. Participants will be authors of scaling studies. We will collect quantitative (questionnaire) and qualitative (semi-structured interview) data. Descriptive analyses will be conducted on quantitative data and constant comparative techniques on qualitative data. DISCUSSION Essential items for reporting scaling studies will contribute to better reporting of scaling studies and facilitate the transparency and scaling of evidence-based health interventions.
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Affiliation(s)
- Amédé Gogovor
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Robert K. D. McLean
- International Development Research Centre, PO BOX 8500, Ottawa, Ontario K1G 3H9 Canada
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 South Africa
| | - David Moher
- School of Epidemiology and Public Health, University Research Chair in Systematic Reviews, Ottawa, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, Centre for Practice Changing Research Building, 501 Smyth Road, PO BOX 201B, Ottawa, Ontario K1H 8L6 Canada
| | - Andrew Milat
- Centre for Epidemiology, NSW Ministry of Health, Australia, LMB 961, North Sydney, 2059 Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building (A27) Fisher Road, Sydney, NSW 2006 Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Karina Prévost
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
- Patient partner, Quebec, Canada
| | - Emmanuelle Aubin
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
- Patient partner, Quebec, Canada
| | - Paula Rochon
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Giraud Ekanmian
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Jasmine Sawadogo
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Nathalie Rheault
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
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Ben Charif A, Croteau J, Adekpedjou R, Zomahoun HTV, Adisso EL, Légaré F. Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients. Med Decis Making 2019; 39:661-672. [PMID: 31423898 DOI: 10.1177/0272989x19866296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Cluster randomized trials are important sources of information on evidence-based practices in primary care. However, there are few sources of intracluster correlation coefficients (ICCs) for designing such trials. We inventoried ICC estimates for shared decision-making (SDM) measures in primary care. Methods. Data sources were studies led by the Canada Research Chair in Shared Decision Making and Knowledge Transition. Eligible studies were conducted in primary care, included at least 2 hierarchical levels, included SDM measures for individual units nested under any type of cluster (area, clinic, or provider), and were approved by an ethics committee. We classified measures into decision antecedents, decision processes, and decision outcomes. We used Bayesian random-effect models to estimate mode ICCs and the 95% highest probability density interval (HPDI). We summarized estimates by calculating median and interquartile range (IQR). Results. Six of 14 studies were included. There were 97 ICC estimates for 17 measures. ICC estimates ranged from 0 to 0.5 (median, 0.03; IRQ, 0-0.07). They were higher for process measures (median, 0.03; IQR, 0-0.07) than for antecedent measures (0.02; 0-0.07) or outcome measures (0.02; 0-0.06), for which, respectively, "decisional conflict" (mode, 0.48; 95% HPDI, 0.39-0.57), "reluctance to disclose uncertainty to patients" (0.5; 0.11-0.89), and "quality of the decision" (0.45; 0.14-0.84) had the highest ICCs. ICCs for provider-level clustering (median, 0.06; IQR, 0-0.13) were higher than for other levels. Limitations. This convenience sample of studies may not reflect all potential ICC ranges for primary care SDM measures. Conclusions. Our inventory of ICC estimates for SDM measures in primary care will improve the ease and accuracy of power calculations in cluster randomized trials and inspire its further expansion in SDM contexts.
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Affiliation(s)
- Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Jordie Croteau
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Evehouenou Lionel Adisso
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Almont T, Bouhnik AD, Ben Charif A, Bendiane MK, Couteau C, Manceau C, Mancini J, Huyghe É. Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study. J Sex Med 2019; 16:96-110. [DOI: 10.1016/j.jsxm.2018.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
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Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, Wiggers J, Milat A, Rissel C, Bauman A, Farrell MM, Légaré F, Ben Charif A, Zomahoun HTV, Hodder RK, Jones J, Booth D, Parmenter B, Regan T, Yoong SL. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane Database Syst Rev 2018; 11:CD012439. [PMID: 30480770 PMCID: PMC6362433 DOI: 10.1002/14651858.cd012439.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes. OBJECTIVES To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff. SEARCH METHODS We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research. SELECTION CRITERIA Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies). DATA COLLECTION AND ANALYSIS Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome. MAIN RESULTS We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search. AUTHORS' CONCLUSIONS Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Sharni Goldman
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanNSWAustralia2287
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Andrew Milat
- NSW Ministry of HealthCentre for Epidemiology and EvidenceNorth SydneyNSWAustralia2060
- The University of SydneySchool of Public HealthSydneyAustralia
| | - Chris Rissel
- Sydney South West Local Health DistrictOffice of Preventive HealthLiverpoolNSWAustralia2170
| | - Adrian Bauman
- The University of SydneySchool of Public HealthSydneyAustralia
- Sax InstituteThe Australian Prevention Partnership CentreSydneyAustralia
| | - Margaret M Farrell
- US National Cancer InstituteDivision of Cancer Control and Population Sciences/Implementation Sciences Team9609 Medical Center DriveBethesdaMarylandUSA20892
| | - France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)Université Laval2525, Chemin de la CanardièreQuebecQuebecCanadaG1J 0A4
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne ‐ Université LavalHealth and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR‐SUPPORT Unit of Québec2525, Chemin de la CanardièreQuebecQCCanadaG1J 0A4
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Benjamin Parmenter
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Tim Regan
- University of NewcastleThe School of PsychologyCallaghanAustralia
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Ben Charif A, Hassani K, Wong ST, Zomahoun HTV, Fortin M, Freitas A, Katz A, Kendall CE, Liddy C, Nicholson K, Petrovic B, Ploeg J, Légaré F. Assessment of scalability of evidence-based innovations in community-based primary health care: a cross-sectional study. CMAJ Open 2018; 6:E520-E527. [PMID: 30389751 PMCID: PMC6221806 DOI: 10.9778/cmajo.20180143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2013, the Canadian Institutes of Health Research funded 12 community-based primary health care research teams to develop evidence-based innovations. We aimed to explore the scalability of these innovations. METHODS In this cross-sectional study, we invited the 12 teams to rate their evidence-based innovations for scalability. Based on a systematic review, we developed a self-administered questionnaire with 16 scalability assessment criteria grouped into 5 dimensions (theory, impact, coverage, setting and cost). Teams completed a questionnaire for each of their innovations. We analyzed the data using simple frequency counts and hierarchical cluster analysis. We calculated the mean number and standard deviation (SD) of innovations that met criteria within each dimension that included more than 1 criterion. The analysis unit was the innovation. RESULTS The 11 responding teams evaluated 33 evidence-based innovations (median 3, range 1-8 per team). The innovations focused on access to care and chronic disease prevention and management, and varied from health interventions to methodological innovations. Most of the innovations were health interventions (n = 21), followed by analytical methods (n = 4), conceptual frameworks (n = 4), measures (n = 3) and strategies to build research capacity (n = 1). Most (29) met criteria in the theory dimension, followed by impact (mean 22.3 [SD 5.6] innovations per dimension), setting (mean 21.7 [SD 8.5]), cost (mean 17.5 [SD 2.1]) and coverage (mean 14.0 [SD 4.1]). On average, the innovations met 10 of the 16 criteria. Adoption was the least assessed criterion (n = 9). Most (20) of the innovations were highly ranked for scalability. INTERPRETATION Scalability varied among innovations, which suggests that readiness for scale up was suboptimal for some innovations. Coverage remained largely unaddressed; further investigation of this critical dimension is necessary.
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Affiliation(s)
- Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Kasra Hassani
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Sabrina T Wong
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Martin Fortin
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Alan Katz
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Claire E Kendall
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Clare Liddy
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Kathryn Nicholson
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Bojana Petrovic
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Jenny Ploeg
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont.
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24
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Ben Charif A, Zomahoun HTV, LeBlanc A, Langlois L, Wolfenden L, Yoong SL, Williams CM, Lépine R, Légaré F. Effective strategies for scaling up evidence-based practices in primary care: a systematic review. Implement Sci 2017; 12:139. [PMID: 29166911 PMCID: PMC5700621 DOI: 10.1186/s13012-017-0672-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 06/27/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023] Open
Abstract
Background While an extensive array of existing evidence-based practices (EBPs) have the potential to improve patient outcomes, little is known about how to implement EBPs on a larger scale. Therefore, we sought to identify effective strategies for scaling up EBPs in primary care. Methods We conducted a systematic review with the following inclusion criteria: (i) study design: randomized and non-randomized controlled trials, before-and-after (with/without control), and interrupted time series; (ii) participants: primary care-related units (e.g., clinical sites, patients); (iii) intervention: any strategy used to scale up an EBP; (iv) comparator: no restrictions; and (v) outcomes: no restrictions. We searched MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and the Cochrane Library from database inception to August 2016 and consulted clinical trial registries and gray literature. Two reviewers independently selected eligible studies, then extracted and analyzed data following the Cochrane methodology. We extracted components of scaling-up strategies and classified them into five categories: infrastructure, policy/regulation, financial, human resources-related, and patient involvement. We extracted scaling-up process outcomes, such as coverage, and provider/patient outcomes. We validated data extraction with study authors. Results We included 14 studies. They were published since 2003 and primarily conducted in low-/middle-income countries (n = 11). Most were funded by governmental organizations (n = 8). The clinical area most represented was infectious diseases (HIV, tuberculosis, and malaria, n = 8), followed by newborn/child care (n = 4), depression (n = 1), and preventing seniors’ falls (n = 1). Study designs were mostly before-and-after (without control, n = 8). The most frequently targeted unit of scaling up was the clinical site (n = 11). The component of a scaling-up strategy most frequently mentioned was human resource-related (n = 12). All studies reported patient/provider outcomes. Three studies reported scaling-up coverage, but no study quantitatively reported achieving a coverage of 80% in combination with a favorable impact. Conclusions We found few studies assessing strategies for scaling up EBPs in primary care settings. It is uncertain whether any strategies were effective as most studies focused more on patient/provider outcomes and less on scaling-up process outcomes. Minimal consensus on the metrics of scaling up are needed for assessing the scaling up of EBPs in primary care. Trial registration This review is registered as PROSPERO CRD42016041461. Electronic supplementary material The online version of this article (10.1186/s13012-017-0672-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - Annie LeBlanc
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada
| | - Léa Langlois
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Roxanne Lépine
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada. .,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525 Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.
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Diouf NT, Ben Charif A, Adisso L, Adekpedjou R, Zomahoun HTV, Agbadjé TT, Dogba MJ, Garvelink MM. Shared decision making in West Africa: The forgotten area. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2017; 123-124:7-11. [DOI: 10.1016/j.zefq.2017.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ben Charif A, Bouhnik AD, Courbière B, Rey D, Préau M, Bendiane MK, Peretti-Watel P, Mancini J. Sexual health problems in French cancer survivors 2 years after diagnosis—the national VICAN survey. J Cancer Surviv 2015; 10:600-9. [DOI: 10.1007/s11764-015-0506-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/06/2015] [Indexed: 01/23/2023]
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Ben Charif A, Bouhnik AD, Rey D, Provansal M, Courbiere B, Spire B, Mancini J. Satisfaction with fertility- and sexuality-related information in young women with breast cancer--ELIPPSE40 cohort. BMC Cancer 2015; 15:572. [PMID: 26239242 PMCID: PMC4523948 DOI: 10.1186/s12885-015-1542-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/13/2015] [Indexed: 11/25/2022] Open
Abstract
Background Young breast cancer survivors are often dissatisfied with the information provided on fertility and sexuality. Our aim was to discuss possible contributing factors and to propose strategies to increase patient satisfaction with such information. Methods Using the French National Health Insurance System database, we constituted the ELIPPSE40 regional cohort of 623 women, aged 18–40, diagnosed with breast cancer between 2005 and 2011. As of January 2014, 319 women had taken part in the 10-, 16-, 28 and 48-month telephone interviews. Satisfaction with the information provided about the potential impact of cancer and its treatment on fertility and sexuality was assessed at 48 months after diagnosis on 5-point Likert scales. Results Four years after diagnosis, only 53.0 and 42.6 % of women were satisfied with fertility- and sexuality-related information, respectively, without any significant change over the 2009–2014 period (P = 0.585 and P = 0.676 respectively). The two issues were moderately correlated (ρ = 0.60; P <0.001). General satisfaction with medical follow-up was the only common correlate. Irrespective of sociodemographic and medical characteristics, satisfaction with fertility-related information was greater among women with a family history of breast/ovarian cancer who had the opportunity to ask questions at the time of cancer disclosure. Satisfaction with sexuality-related information increased with the spontaneous provision of information by physicians at cancer disclosure. Conclusions Promoting both patients’ question asking behavior and more systematic information could improve communication between caregivers and young breast cancer survivors and address distinct unmet needs regarding fertility- and sexuality- related information. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1542-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ali Ben Charif
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,UMR_S912, IRD, Aix Marseille Université, Marseille, France. .,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Anne-Déborah Bouhnik
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,UMR_S912, IRD, Aix Marseille Université, Marseille, France.
| | - Dominique Rey
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,UMR_S912, IRD, Aix Marseille Université, Marseille, France. .,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Magali Provansal
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,Institut Paoli-Calmettes, Marseille, France.
| | - Blandine Courbiere
- IMBE UMR7263, Aix Marseille Université, CNRS, IRD, Avignon Université, Marseille, France. .,Department of Obstetrics, Gynecology and Reproductive Medicine, APHM, La Conception Hospital, Marseille, France.
| | - Bruno Spire
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,UMR_S912, IRD, Aix Marseille Université, Marseille, France. .,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Julien Mancini
- UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006,, Marseille, France. .,UMR_S912, IRD, Aix Marseille Université, Marseille, France. .,BiosTIC, La Timone Hospital, APHM, Marseille, France. .,UMR912, SESSTIM, "Cancers, Biomedicine & Society" group, Institut Paoli-Calmettes, 232 Bd Ste Marguerite, 13273, Marseille, France.
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