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Juras MM, Coelho ACF, Vázquez AL, Ribeiro M, Kohlsdorf M, Custódio AL, Amador Buenabad NG, Perez LV, Hooley C, Barnett ML, Baumann AA. Parenting practices and interventions during the COVID-19 pandemic lockdown: an exploratory cross-sectional study of caregivers in Brazil, Mexico, and the United States. Psicol Reflex Crit 2024; 37:12. [PMID: 38583110 PMCID: PMC10999397 DOI: 10.1186/s41155-024-00295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic led countries' governments to rapidly establish lockdowns and social distancing, which altered family routines and the quality of family relationships worldwide. OBJECTIVES This exploratory cross-sectional study aimed to identify the impacts of the social distancing and lockdown in parenting practices of caregivers from Brazil, Mexico, and the USA, and to analyze the continuity of parenting intervention support for children and their families at the beginning of the pandemic in these countries. METHODS The sample consisted of 704 caregivers of children (286 from Brazil, 225 from Mexico, and 193 from the USA) who answered an online survey about parenting practices before/after quarantine, caregiver/child routines, feelings related to quarantine, changes in everyday life since the beginning of the COVID-19 pandemic, contact with health professionals, and sources of parenting information. RESULTS Data indicate that caregivers from the three countries experienced similar parenting practices during this time, and did not report significant changes before and after the lockdown. They sought information about parenting predominantly via social media. Those receiving previous mental health care perceived the transition from in-person to telehealth services during the pandemic as feasible and acceptable. CONCLUSION This study will be helpful for clinicians and parents to contextualize their practices amid long-standing effects that the COVID-19 pandemic can have on children and their families during and post-pandemic from multiple cultural backgrounds.
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Affiliation(s)
| | | | | | | | | | | | | | - Lucia Vazquez Perez
- National Institute of Psychiatry Ramon de la Fuente Muniz, Huntsville, Mexico
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Holzer KJ, Bartosiak KA, Calfee RP, Hammill CW, Haroutounian S, Kozower BD, Cordner TA, Lenard EM, Freedland KE, Tellor Pennington BR, Wolfe RC, Miller JP, Politi MC, Zhang Y, Yingling MD, Baumann AA, Kannampallil T, Schweiger JA, McKinnon SL, Avidan MS, Lenze EJ, Abraham J. Perioperative mental health intervention for depression and anxiety symptoms in older adults study protocol: design and methods for three linked randomised controlled trials. BMJ Open 2024; 14:e082656. [PMID: 38569683 DOI: 10.1136/bmjopen-2023-082656] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncological and orthopaedic, investigating whether a perioperative mental health intervention, with psychological and pharmacological components, reduces perioperative symptoms of depression and anxiety in older surgical patients. METHODS AND ANALYSIS Adults ≥60 years undergoing cardiac, orthopaedic or oncological surgery will be enrolled in one of three-linked type 1 hybrid effectiveness/implementation RCTs that will be conducted in tandem with similar methods. In each trial, 100 participants will be randomised to a remotely delivered perioperative behavioural treatment incorporating principles of behavioural activation, compassion and care coordination, and medication optimisation, or enhanced usual care with mental health-related resources for this population. The primary outcome is change in depression and anxiety symptoms assessed with the Patient Health Questionnaire-Anxiety Depression Scale from baseline to 3 months post surgery. Other outcomes include quality of life, delirium, length of stay, falls, rehospitalisation, pain and implementation outcomes, including study and intervention reach, acceptability, feasibility and appropriateness, and patient experience with the intervention. ETHICS AND DISSEMINATION The trials have received ethics approval from the Washington University School of Medicine Institutional Review Board. Informed consent is required for participation in the trials. The results will be submitted for publication in peer-reviewed journals, presented at clinical research conferences and disseminated via the Center for Perioperative Mental Health website. TRIAL REGISTRATION NUMBERS NCT05575128, NCT05685511, NCT05697835, pre-results.
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Affiliation(s)
- Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kimberly A Bartosiak
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ryan P Calfee
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Theresa A Cordner
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Emily M Lenard
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Bethany R Tellor Pennington
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - J Philip Miller
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Sherry L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
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Hankins JS, Lobo C, Braga JAP, Aurora T, Pimenta K, Figueiredo MS, Baumann AA. Health-care transition services for sickle cell disease in Brazil. Lancet Haematol 2024; 11:e184-e185. [PMID: 38428445 DOI: 10.1016/s2352-3026(24)00043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Clarisse Lobo
- Instituto de Hematologia Arthur Siqueira Cavalcanti, HEMORIO, Rio de Janeiro, Brazil
| | | | - Tarun Aurora
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kelly Pimenta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; School of Public Health, University of Memphis, Memphis, TN, USA
| | | | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, USA
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Abraham J, Holzer KJ, Lenard EM, Meng A, Pennington BRT, Wolfe RC, Haroutounian S, Calfee R, Hammil CW, Kozower BD, Cordner TA, Schweiger J, McKinnon S, Yingling M, Baumann AA, Politi MC, Kannampallil T, Miller JP, Avidan MS, Lenze EJ. A Perioperative Mental Health Intervention for Depressed and Anxious Older Surgical Patients: Results From a Feasibility Study. Am J Geriatr Psychiatry 2024; 32:205-219. [PMID: 37798223 PMCID: PMC10852892 DOI: 10.1016/j.jagp.2023.09.003] [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: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. METHODS We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. RESULTS Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). CONCLUSIONS The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO.
| | - Katherine J Holzer
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Emily M Lenard
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Alicia Meng
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Bethany R Tellor Pennington
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Rachel C Wolfe
- Department of Pharmacy (RCW), Barnes-Jewish Hospital, St. Louis, MO
| | - Simon Haroutounian
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Ryan Calfee
- Department of Orthopaedic Surgery (RC), Washington University School of Medicine, St. Louis, MO
| | - Chet W Hammil
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Theresa A Cordner
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Julia Schweiger
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Sherry McKinnon
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Michael Yingling
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Mary C Politi
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Thomas Kannampallil
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - J Philip Miller
- Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
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Rakhra A, Hooley C, Fort MP, Weber MB, Price L, Nguyen HL, Ramirez M, Muula AS, Hosseinipour M, Apusiga K, Davila-Roman V, Gyamfi J, Adjei KGA, Andesia J, Fitzpatrick A, Launois P, Baumann AA. Training in eight low-and middle-income countries: lessons learned from a pilot study using the WHO-TDR dissemination and implementation massive open online course. Front Health Serv 2024; 3:1217619. [PMID: 38313329 PMCID: PMC10834670 DOI: 10.3389/frhs.2023.1217619] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024]
Abstract
Introduction Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in low-and middle- income countries (LMICs). Despite this, a lack of funding, training and mentorship for NCD investigators in LMICs exists. In an effort to gain knowledge and skills to address these gaps, participants from the Global Research on Implementation and Translation Science (GRIT), a consortium of studies in eight LMICs and their networks, attended the dissemination and implementation (D&I) massive open online course (MOOC) developed by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization to strengthen D&I capacity building. Here, we report on the pilot of this MOOC, which was implemented during the SARS COVID-19 pandemic from April- November 2020. Methods Participants completed pre-and post-training questionnaires to assess self-reported D&I competencies, general research skills, and research mentor access and quality. D&I competencies were measured by use of a scale developed for a US-based training program, with change in competency scores assessed by paired t test. We used univariate statistics to analyze the data for all other outcomes. Results Of the 247 participants enrolled, 32 (13%) completed all course requirements, 21 (9%) completed the pre-and post-surveys and are included in the analysis. D&I competency scores suggest improvement for those who had complete pre- and post-assessments. Trainee's average score on the full competency scale improved 1.45 points (0-5 scale) from pre- to post-test; all four subscales also showed evidence of improvements. There were small but not significant increases in competencies for grant writing, proposal/ manuscript writing and presentations from pre- to post-test assessment. 40% of trainees reported access to a research mentor and 12% reported access to a D&I specific mentor. Participants reported barriers (e.g., unstable internet access and challenges due to COVID-19) and facilitators (e.g., topical interests, collaboration with colleagues) to completing the MOOC. Conclusions Although COVID-19 affected program usage and completion, the MOOC was feasible. We also had signals of effectiveness, meaning among LMIC participants completing the course, there was improvement in self-report D&I competency scores. Recommendations for future D&I trainings in LMICs include (1) adding more topic specific modules (i.e., NCD research, general research skills) for scalability; (2) fostering more collaboration with participants across LMICs; and (3) establishing partnerships with D&I mentors for course participants.
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Affiliation(s)
- Ashlin Rakhra
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Meredith P. Fort
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Mary Beth Weber
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - LeShawndra Price
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Hoa L. Nguyen
- Epidemiology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Manuel Ramirez
- Center for the Prevention of Chronic Diseases -CIIPEC, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | - Mina Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Victor Davila-Roman
- School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Joyce Gyamfi
- Global Health Program, New York University Global College of Public Health, New York City, NY, United States
| | | | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Moi University, Eldoret, Kenya
| | - Annette Fitzpatrick
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Pascal Launois
- Research Capacity Strengthening (RCS) Unit, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
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Bello-Manga H, Haliru L, Ahmed K, Ige S, Musa H, Muhammad-Idris ZK, Monday B, Sani AM, Bonnet K, Schlundt DG, Varughese T, Tabari AM, DeBaun MR, Baumann AA, King AA. Barriers and facilitators to a task-shifted stroke prevention program for children with sickle cell anemia in a community hospital: a qualitative study. Implement Sci Commun 2024; 5:10. [PMID: 38225633 PMCID: PMC10790401 DOI: 10.1186/s43058-023-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups. METHODS We conducted a descriptive qualitative study in a community hospital in Kaduna, Nigeria, using focus groups and interviews. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework and the Theory of Planned Behavior. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology. RESULTS We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system. CONCLUSION Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity for TCD screening of children with SCD that is more sustainable. TRIAL REGISTRATION NCT05434000.
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Affiliation(s)
- Halima Bello-Manga
- Department of Haematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria.
| | - Lawal Haliru
- Department of Paediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Kudirat Ahmed
- Department of Paediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Samuel Ige
- Yusuf Dantsoho Memorial Hospital, Kaduna State Ministry of Health, Kaduna, Nigeria
| | - Hayatu Musa
- Department of Library and Information Science, Ahmadu Bello University, Zaria, Nigeria
| | | | - Binshak Monday
- Department of Library and Information Science, Ahmadu Bello University, Zaria, Nigeria
| | | | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Taniya Varughese
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Abdulkadir M Tabari
- Department of Radiology, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Michael R DeBaun
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University of School of Medicine, Nashville, TN, USA
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
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Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
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Abstract
OBJECTIVE To provide guiding principles and recommendations for how approaches from the field of dissemination and implementation (D&I) science can advance healthcare equity. DATA SOURCES AND STUDY SETTING This article, part of a special issue sponsored by the Agency for Healthcare Research and Quality (AHRQ), is based on an outline drafted to support proceedings of the 2022 AHRQ Health Equity Summit and further revised to reflect input from Summit attendees. STUDY DESIGN This is a narrative review of the current and potential applications of D&I approaches for understanding and advancing healthcare equity, followed by discussion and feedback with Summit attendees. DATA COLLECTION/EXTRACTION METHODS We identified major themes in narrative and systematic reviews related to D&I science, healthcare equity, and their intersections. Based on our expertise, and supported by synthesis of published studies, we propose recommendations for how D&I science is relevant for advancing healthcare equity. We used iterative discussions internally and at the Summit to refine preliminary findings and recommendations. PRINCIPAL FINDINGS We identified four guiding principles and three D&I science domains with strong promise for accelerating progress toward healthcare equity. We present eight recommendations and more than 60 opportunities for action by practitioners, healthcare leaders, policy makers, and researchers. CONCLUSIONS Promising areas for D&I science to impact healthcare equity include the following: attention to equity in the development and delivery of evidence-based interventions; the science of adaptation; de-implementation of low-value care; monitoring equity markers; organizational policies for healthcare equity; improving the economic evaluation of implementation; policy and dissemination research; and capacity building.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel C. Shelton
- Department of Sociomedical SciencesColumbia University, Mailman School of Public HealthNew YorkNew YorkUSA
| | - Shiriki Kumanyika
- Drexel Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Debra Haire‐Joshu
- Brown School of Public Health and School of MedicineWashington University in St. LouisSt. LouisMissouriUSA
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9
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Baumann AA, Hankins JS, Hsu LL, Gibson RW, Richardson LD, Treadwell M, Glassberg JA, Bourne S, Luo L, Masese RV, Demartino T, Nocek J, Taaffe E, Gollan S, Ruiz OO, Nwosu C, Qashou N, James AS, Tanabe P, King AA. "The project did not come to us with a solution": Perspectives of research teams on implementing a study about electronic health record-embedded individualized pain plans for emergency department treatment of vaso-occlusive episodes in adults with sickle cell disease. BMC Health Serv Res 2023; 23:1245. [PMID: 37953236 PMCID: PMC10641983 DOI: 10.1186/s12913-023-10255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to capture the implementation process of the ALIGN Study, (An individualized Pain Plan with Patient and Provider Access for Emergency Department care of Sickle Cell Disease). ALIGN aimed to embed Individualized Pain Plans in the electronic health record (E-IPP) and provide access to the plan for both adult patients with sickle cell disease (SCD) and emergency department providers when a person with SCD comes to the emergency department in vaso-occlusive crises. METHODS Semi-structured interviews were conducted with research teams from the 8 participating sites from the ALIGN study. Seventeen participants (principal investigators and study coordinators) shared their perspectives about the implementation of ALIGN in their sites. Data were analyzed in three phases using open coding steps adapted from grounded theory and qualitative content analysis. RESULTS A total of seven overarching themes were identified: (1) the E-IPP structure (location and upkeep) and collaboration with the informatics team, (2) the role of ED champion, (3) the role of research coordinators, (4) research team communication, and communication between research team and clinical team, (5) challenges with the study protocol, (6) provider feedback: addressing over-utilizers, patient mistrust, and the positive feedback about the intervention, and (7) COVID-19 and its effects on study implementation. CONCLUSIONS Findings from this study contribute to learning how to implement E-IPPs for adult patients with SCD in ED. The study findings highlight the importance of early engagement with different team members, a champion from the emergency department, study coordinators with different skills and enhancement of communication and trust among team members. Further recommendations are outlined for hospitals aiming to implement E-IPP for patients with SCD in ED.
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Grants
- U24 HL133948 NHLBI NIH HHS
- U01 HL134042 NHLBI NIH HHS
- U01 HL133994 NHLBI NIH HHS
- U01 HL133964 NHLBI NIH HHS
- U01 HL134007 NHLBI NIH HHS
- U01 HL133997 NHLBI NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NHLBI NIH HHS
- U01 HL134004 NHLBI NIH HHS
- U01 HL133990 NHLBI NIH HHS
- U01 HL133996 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
- National Institute on Minority Health and Health Disparities
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Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA.
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Lynne D Richardson
- Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York City, NY, USA
| | - Marsha Treadwell
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Bourne
- Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Lingzi Luo
- School of Global Public Health, New York University, New York City, NY, USA
| | | | | | - Judith Nocek
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Taaffe
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | | | - Ome-Ollin Ruiz
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Chinonyelum Nwosu
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Hematology, St. Jude, Memphis, TN, USA
| | - Nai Qashou
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
| | - Allison A King
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
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10
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Brewer SK, Corbin CM, Baumann AA, Stirman SW, Jones JM, Pullmann MD, Lyon AR. Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): A modified Delphi study. Res Sq 2023:rs.3.rs-3467152. [PMID: 37961432 PMCID: PMC10635387 DOI: 10.21203/rs.3.rs-3467152/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. Method MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. Results In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. Discussion MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.
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Affiliation(s)
| | | | - Ana A Baumann
- Washington University School of Medicine in Saint Louis: Washington University in St Louis School of Medicine
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11
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Aschbrenner KA, Oh AY, Tabak RG, Hannon PA, Angier HE, Moore WT, Likumahuwa-Ackman S, Carroll JK, Baumann AA, Beidas RS, Mazzucca-Ragan S, Waters EA, Sadasivam RS, Shelton RC. Integrating a focus on health equity in implementation science: Case examples from the national cancer institute's implementation science in cancer control centers (ISC 3) network. J Clin Transl Sci 2023; 7:e226. [PMID: 38028358 PMCID: PMC10643915 DOI: 10.1017/cts.2023.638] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute's (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts. Methods HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019-2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains. Results Centers reported a range of approaches focusing on health equity in implementation research and capacity-building efforts, including (1) engaging diverse community partners/settings in making decisions about research priorities and projects; (2) applying health equity within a single TMF applied across projects or various TMFs used in specific projects; (3) evaluating health equity in operationalizing and measuring health and implementation outcomes; (4) building capacity for health equity-focused implementation science among trainees, early career scholars, and partnering organizations; and (5) leveraging varying levels of institutional resources and efforts to engage, include, and support underrepresented scholars. Conclusions Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers' efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.
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Affiliation(s)
- Kelly A. Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - April Y. Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel G. Tabak
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Peggy A. Hannon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heather E. Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - W. Todd Moore
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Erika A. Waters
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajani S. Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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12
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Weber MB, Baumann AA, Rakhra A, Akwanalo C, Gladys Amaning Adjei K, Andesia J, Apusiga K, Ha DA, Hosseinipour MC, Muula AS, Nguyen HL, Price LN, Ramirez-Zea M, Fitzpatrick AL, Fort MP. Global implementation research capacity building to address cardiovascular disease: An assessment of efforts in eight countries. PLOS Glob Public Health 2023; 3:e0002237. [PMID: 37708090 PMCID: PMC10501667 DOI: 10.1371/journal.pgph.0002237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
Cardiovascular diseases are the leading causes of morbidity and mortality worldwide, but implementation of evidence-based interventions for risk factors such as hypertension is lacking, particularly in low and middle income countries (LMICs). Building implementation research capacity in LMICs is required to overcome this gap. Members of the Global Research on Implementation and Translation Science (GRIT) Consortium have been collaborating in recent years to establish a research and training infrastructure in dissemination and implementation to improve hypertension care. GRIT includes projects in Ghana, Guatemala, India, Kenya, Malawi, Nepal, Rwanda, and Vietnam. We collected data from each site on capacity building activities using the Potter and Brough (2004) model, mapping formal and informal activities to develop (a) structures, systems and roles, (b) staff and infrastructure, (c) skills, and (d) tools. We captured information about sites' needs assessments and metrics plus program adaptations due to the COVID-19 pandemic. All sites reported capacity building activities in each layer of the Capacity Pyramid, with the largest number of activities in the Skills and Tools categories, the more technical and easier to implement categories. All sites included formal and informal training to build Skills. All sites included a baseline needs assessment to guide capacity building activities or assess context and inform intervention design. Sites implementing evidence-based hypertension interventions used common implementation science frameworks to evaluate implementation outcomes. Although the COVID-19 pandemic affected timelines and in-person events, all projects were able to pivot and carry out planned activities. Although variability in the activities and methods used existed, GRIT programs used needs assessments to guide locally appropriate design and implementation of capacity building activities. COVID-19 related changes were necessary, but strong collaborations and relationships with health ministries were maintained. The GRIT Consortium is a model for planning capacity building in LMICs.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ashlin Rakhra
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, United States of America
| | | | - Kezia Gladys Amaning Adjei
- Department of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Kingsley Apusiga
- Department of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Duc A. Ha
- Health Strategy and Policy Institute, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Mina C. Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Adamson S. Muula
- College of Medicine, University of Malawi and the Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hoa L. Nguyen
- University of Massachusetts Chan Medical School, Boston, Massachusetts, United States of America
| | - LeShawndra N. Price
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Annette L. Fitzpatrick
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Meredith P. Fort
- Colorado School of Public Health, University of Colorado – Anschutz Medical Campus, Aurora, Colorado, United States of America
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13
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Lau AS, Huey SJ, Baumann AA. Advances in the adaptation and implementation of evidence-based interventions for historically marginalized groups. Behav Res Ther 2023; 168:104377. [PMID: 37531808 DOI: 10.1016/j.brat.2023.104377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
This collection of six articles showcases innovative approaches to adapting and deploying evidence-based interventions with individuals from historically marginalized groups to advance mental health equity. The field of cultural adaptation has matured beyond initial questions about whether specific culturally adapted interventions work, and must now adopt designs that can yield generalizable knowledge concerning how and under what circumstances such adaptations can promote improved engagement and effectiveness with underserved groups. Crucial to this goal is identifying the target mechanisms presumed to underlie poorer clinical and engagement outcomes among minoritized groups that must be addressed by the adaptation. Furthermore, contributors have gone beyond adaptations to EBI therapeutic content and processes, to the mobilization of implementation strategies that increase the reach and impact of EBIs outside conventional service settings. Our featured investigators have also illuminated critical modifications to the entire research enterprise to center community needs in the conduct of intervention research with historically marginalized groups. We are grateful for the opportunity to highlight these contributions spanning intervention science, adaptation science, and implementation science in Behaviour Research and Therapy.
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Affiliation(s)
- Anna S Lau
- Department of Psychology, University of California Los Angeles, USA.
| | - Stanley J Huey
- Department of Psychology, University of Southern California, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine, USA
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14
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Bello-Manga H, Haliru L, Ahmed K, Ige S, Musa H, Muhammad-Idris ZK, Monday B, Sani AM, Bonnet K, Schlundt DG, Varughese T, Tabari AM, DeBaun MR, Baumann AA, King AA. Barriers and Facilitators to a Task-Shifted Stroke Prevention Program for Children with Sickle Cell Anemia in a Community Hospital: A Qualitative Study. Res Sq 2023:rs.3.rs-2985921. [PMID: 37461538 PMCID: PMC10350163 DOI: 10.21203/rs.3.rs-2985921/v1] [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] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Background Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups. Methods We conducted focus groups with health care providers and interviews with administrative leadership of the community hospital. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology. Results We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system. Conclusion Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity that is more sustainable. Trial registration NCT05434000.
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Affiliation(s)
| | | | | | - Samuel Ige
- Yusuf Dantsoho Memorial Hospital, Ministry of Health, Kaduna
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15
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Walsh-Bailey C, Gilbert A, Shato T, Sandler B, Baumann AA, Bradley CD, McLoughlin GM, McGuire FH, Fort MP, Tabak RG. Protocol for a scoping review of health equity frameworks and models applied in empirical studies of chronic disease prevention and control. Syst Rev 2023; 12:83. [PMID: 37170261 PMCID: PMC10176929 DOI: 10.1186/s13643-023-02240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Chronic diseases, such as cancers and cardiovascular diseases, present the greatest burden of morbidity and mortality worldwide. This burden disproportionately affects historically marginalized populations. Health equity is rapidly gaining increased attention in public health, health services, and implementation research, though many health inequities persist. Health equity frameworks and models (FM) have been called upon to guide equity-focused chronic disease and implementation research. However, there is no clear synthesis of the health equity FM used in chronic disease research or how these are applied in empirical studies. This scoping review seeks to fill this gap by identifying and characterizing health equity FM applied in empirical studies along the chronic disease prevention and control continuum, describing how these FM are used, and exploring potential applications to the field of implementation science. METHODS We follow established guidance for conducting scoping reviews, which includes six stages: (1) identify the research question; (2) identify relevant studies; (3) select studies for inclusion; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) consultation. This protocol presents the iterative, collaborative approach taken to conceptualize this study and develop the search strategy. We describe the criteria for inclusion in this review, methods for conducting two phases of screening (title and abstract, full text), data extraction procedures, and quality assurance approaches taken throughout the project. DISCUSSION The findings from this review will inform health-equity focused chronic disease prevention and control research. FM identified through this review will be added to an existing website summarizing dissemination and implementation science frameworks, and we will offer case examples and recommendations for utilizing a health equity FM in empirical studies. Our search strategy and review methodology may serve as an example for scholars seeking to conduct reviews of health equity FM in other health disciplines. SYSTEMATIC REVIEW REGISTRATION Open Science Framework Registration https://doi.org/10.17605/OSF.IO/SFVE6.
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Affiliation(s)
- Callie Walsh-Bailey
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Amanda Gilbert
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Thembekile Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Cory D Bradley
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Gabriella M McLoughlin
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- College of Public Health, Temple University, 1800 N. Broad St, Philadelphia, PA, 19121, USA
| | - F Hunter McGuire
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Meredith P Fort
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13055 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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16
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Heiden BT, Eaton DB, Chang SH, Yan Y, Baumann AA, Schoen MW, Tohmasi S, Rossetti NE, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non-Small Cell Lung Cancer. JAMA Surg 2023; 158:293-301. [PMID: 36652269 PMCID: PMC9857796 DOI: 10.1001/jamasurg.2022.6826] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023]
Abstract
Importance Surgical resection remains the preferred treatment for functionally fit patients diagnosed with early-stage non-small cell lung cancer (NSCLC). Process-based intraoperative quality metrics (QMs) are important for optimizing long-term outcomes following curative-intent resection. Objective To develop a practical surgical quality score for patients diagnosed with clinical stage I NSCLC who received definitive surgical treatment. Design, Setting, and Participants This retrospective cohort study used a uniquely compiled data set of US veterans diagnosed with clinical stage I NSCLC who received definitive surgical treatment from October 2006 through September 2016. The data were analyzed from April 1 to September 1, 2022. Based on contemporary treatment guidelines, 5 surgical QMs were defined: timely surgery, minimally invasive approach, anatomic resection, adequate lymph node sampling, and negative surgical margin. The study developed a surgical quality score reflecting the association between these QMs and overall survival (OS), which was further validated in a cohort of patients using data from the National Cancer Database (NCDB). The study also examined the association between the surgical quality score and recurrence-free survival (RFS). Exposures Surgical treatment of early-stage NSCLC. Main Outcomes and Measures Overall survival and RFS. Results The study included 9628 veterans who underwent surgical treatment between 2006 and 2016. The cohort consisted of 1446 patients who had a mean (SD) age of 67.6 (7.9) years and included 9278 males (96.4%) and 350 females (3.6%). Among the cohort, 5627 individuals (58.4%) identified as being smokers at the time of surgical treatment. The QMs were met as follows: timely surgery (6633 [68.9%]), minimally invasive approach (3986 [41.4%]), lobectomy (6843 [71.1%]) or segmentectomy (532 [5.5%]), adequate lymph node sampling (3278 [34.0%]), and negative surgical margin (9312 [96.7%]). The median (IQR) follow-up time was 6.2 (2.5-11.4) years. An integer-based score (termed the Veterans Affairs Lung Cancer Operative quality [VALCAN-O] score) from 0 (no QMs met) to 13 (all QMs met) was constructed, with higher scores reflecting progressively better risk-adjusted OS. The median (IQR) OS differed substantially between the score categories (score of 0-5 points, 2.6 [1.0-5.7] years of OS; 6-8 points, 4.3 [1.7-8.6] years; 9-11 points, 6.3 [2.6-11.4] years; and 12-13 points, 7.0 [3.0-12.5] years; P < .001). In addition, risk-adjusted RFS improved in a stepwise manner between the score categories (6-8 vs 0-5 points, multivariable-adjusted hazard ratio [aHR], 0.62; 95% CI, 0.48-0.79; P < .001; 12-13 vs 0-5 points, aHR, 0.39; 95% CI, 0.31-0.49; P < .001). In the validation cohort, which included 107 674 nonveteran patients, the score remained associated with OS. Conclusions and Relevance The findings of this study suggest that adherence to intraoperative QMs may be associated with improved OS and RFS. Efforts to improve adherence to surgical QMs may improve patient outcomes following curative-intent resection of early-stage lung cancer.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Su-Hsin Chang
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Yan Yan
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Martin W. Schoen
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Hematology and Medical Oncology, Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri
| | - Steven Tohmasi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Nikki E. Rossetti
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
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Heiden BT, Eaton DB, Chang SH, Yan Y, Baumann AA, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Racial Disparities in the Surgical Treatment of Clinical Stage I Non-Small Cell Lung Cancer Among Veterans. Chest 2022; 162:920-929. [PMID: 35405111 PMCID: PMC9562435 DOI: 10.1016/j.chest.2022.03.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prior studies in the civilian population have reported racial disparities in lung cancer outcomes following surgical treatment, including inferior quality of care and worse survival. It is unclear if racial disparities exist in the Veterans Health Administration (VHA), the largest integrated health care system in the United States. RESEARCH QUESTION Do racial disparities affect early-stage non-small cell lung cancer (NSCLC) outcomes following surgical treatment within the VHA? STUDY DESIGN AND METHODS This retrospective cohort study was conducted in veterans with clinical stage I NSCLC undergoing surgical treatment in the VHA system. Demographic characteristics, access to care, surgical quality measures, and short- and long-term oncologic outcomes between White and Black veterans were evaluated. RESULTS From 2006 to 2016, a total of 18,800 veterans with clinical stage I NSCLC were included. The rates of definitive surgical treatment were similar between Black (57.3%) and White (58.1%) veterans (P = .42). The final study cohort included 9,842 patients receiving surgical treatment, of whom 8,356 (84.9%) were White and 1,486 (15.1%) were Black. Black patients were younger and more likely to smoke, although comorbidities were similar between the two groups. Black patients were somewhat less likely to receive adequate lymph node sampling (30.6% vs 33.3%; P = .050); however, other access-to-care metrics and surgical quality measures, including rates of anatomic lobectomy (71.9% vs 69.4%; P = .189) and positive margins (3.2% vs 3.1%; P = .955), were similar between the two groups. Although Black veterans were less likely to experience major postoperative complications, there was no difference in 30-day readmission, 30-day mortality, or disease-free survival between the two groups. Black patients had significantly better risk-adjusted overall survival (hazard ratio, 0.802; 95% CI, 0.729-0.883; P < .001). INTERPRETATION Among veterans with NSCLC undergoing surgical treatment through the VHA, Black patients received comparable care with equivalent if not superior outcomes compared with White patients.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, MO; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
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18
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Charles ME, Kuroki LM, Baumann AA, Tabak RG, James A, Cooksey K, Politi MC. A case study of adapting a health insurance decision intervention from trial into routine cancer care. BMC Res Notes 2022; 15:298. [PMID: 36088371 PMCID: PMC9463661 DOI: 10.1186/s13104-022-06189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
This study adapted Improving Cancer Patients’ Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (> 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact.
Results
Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise.
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Abraham J, Holzer KJ, Lenard EM, Freedland KE, Tellor Pennington BR, Wolfe RC, Cordner TA, Baumann AA, Politi M, Avidan MS, Lenze E. Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study. BMJ Open 2022; 12:e062398. [PMID: 35998971 PMCID: PMC9403127 DOI: 10.1136/bmjopen-2022-062398] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisation. These experiences can, in turn, exacerbate anxiety and depressive symptoms. Despite these risks, little is known about how to treat perioperative anxiety and depression among older adults. METHODS AND ANALYSIS We designed a feasibility study of a perioperative mental health intervention bundle to improve perioperative mental health, specifically depression and anxiety. The overarching goals of this study are twofold: first, to adapt and refine an intervention bundle comprised of behavioural activation and medication optimisation to meet the needs of older adults within three surgical patient populations (ie, orthopaedic, oncological and cardiac); and second, to test the feasibility of study procedures and intervention bundle implementation. Quantitative data on clinical outcomes such as depression, anxiety, quality of life, delirium, falls, length of stay, hospitalisation and pain will be collected and tabulated for descriptive purposes. A hybrid inductive-deductive thematic approach will be employed to analyse qualitative feedback from key stakeholders. ETHICS AND DISSEMINATION The study received approval from the Washington University Institutional Review Board. Results of this study will be presented in peer-reviewed journals, at professional conferences, and to our perioperative mental health advisory board. TRIAL REGISTRATION NUMBER NCT05110690.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Emily M Lenard
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Theresa A Cordner
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Ana A Baumann
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Mary Politi
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Michael Simon Avidan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Eric Lenze
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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20
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Baumann AA, Hooley C, Kryzer E, Morshed AB, Gutner CA, Malone S, Walsh-Bailey C, Pilar M, Sandler B, Tabak RG, Mazzucca S. A scoping review of frameworks in empirical studies and a review of dissemination frameworks. Implement Sci 2022; 17:53. [PMID: 35945548 PMCID: PMC9361268 DOI: 10.1186/s13012-022-01225-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks. METHODS To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks. FINDINGS Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined. IMPLICATION FOR D&I RESEARCH This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.
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Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, USA.
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, USA
| | - Emily Kryzer
- BJC HealthCare, Community Health Improvement, St. Louis, USA
| | | | - Cassidy A Gutner
- ViiV Healthcare, Research Triangle Park, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Sara Malone
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Callie Walsh-Bailey
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Brittney Sandler
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Rachel G Tabak
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Stephanie Mazzucca
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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Calhoun C, Luo L, Baumann AA, Bauer A, Shen E, McKay V, Hooley C, James A, King AA. Transition for Adolescents and Young Adults With Sickle Cell Disease in a US Midwest Urban Center: A Multilevel Perspective on Barriers, Facilitators, and Future Directions. J Pediatr Hematol Oncol 2022; 44:e872-e880. [PMID: 35731941 PMCID: PMC9218344 DOI: 10.1097/mph.0000000000002322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD), an inherited red blood cell disorder, primarily affects African Americans in the United States. Adolescents and young adults with SCD (AYA-SCD) are at risk of high morbidity and mortality when transitioning from pediatric to adult care. The goal of this qualitative study was to understand factors associated with optimal implementation of the AYA-SCD transition. METHODS Participants were recruited from a large hospital system and the community. Interview guides included topics on access to primary and specialized care, beliefs and practices related to pain control, transition from pediatric to adult care, and patient experiences in the emergency department. Data were coded and analyzed using an inductive thematic coding approach in combination with a deductive coding approach using domains from the Consolidated Framework for Implementation Research (CFIR). RESULTS Fifty-nine participants, including 21 AYA-SCD from both the pediatric and adult clinics, 17 caregivers, 9 pediatric SCD providers, 6 adult SCD providers, and 6 emergency department providers, completed 11 focus groups and 5 semistructured interviews. Results identified multiple factors within the domains of CFIR including the outer setting, inner setting, individual characteristics, and intervention characteristics. Results were incorporated into a transition framework to inform local practice improvement. CONCLUSION Our study highlights the importance of multilevel barriers and facilitators for AYA-SCD transition from pediatric to adult care. Future studies could use implementation science frameworks to understand local context and identify strategies and intervention characteristics to improve transition programming. These efforts will ultimately reduce health disparities and ensure health equity.
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Affiliation(s)
- Cecelia Calhoun
- Department of Pediatrics, Washington University School of Medicine
| | - Lingzi Luo
- Program in Occupational Therapy, Washington University School of Medicine
| | - Ana A. Baumann
- Washington University in St. Louis, Brown School of Social Work
| | - Anna Bauer
- Program in Occupational Therapy, Washington University School of Medicine
| | - Evelyn Shen
- Program in Occupational Therapy, Washington University School of Medicine
| | - Virginia McKay
- Washington University in St. Louis, Brown School of Social Work
| | - Cole Hooley
- Washington University in St. Louis, Brown School of Social Work
| | - Aimee James
- Division of Public Health Sciences, Washington University School of Medicine
| | - Allison A. King
- Department of Pediatrics, Washington University School of Medicine
- Program in Occupational Therapy, Washington University School of Medicine
- Division of Public Health Sciences, Washington University School of Medicine
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22
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Baumann AA, Woodward EN, Singh RS, Adsul P, Shelton RC. Assessing researchers' capabilities, opportunities, and motivation to conduct equity-oriented dissemination and implementation research, an exploratory cross-sectional study. BMC Health Serv Res 2022; 22:731. [PMID: 35650573 PMCID: PMC9161573 DOI: 10.1186/s12913-022-07882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A recent paradigm shift has led to an explicit focus on enhancing health equity through equity-oriented dissemination and implementation (D&I) research. However, the integration and bidirectional learning across these two fields is still in its infancy and siloed. This exploratory study aimed to examine participants' perceived capabilities, opportunities, and motivations to conduct equity-oriented D&I research. METHODS We conducted an exploratory cross-sectional survey distributed online from December 2020 to April 2021. Participants were recruited at either D&I or health disparities-oriented conferences, meetings, through social media, or personal outreach via emails. Informed by the Capability, Opportunity, and Motivation Model (COM-B), the survey queried respondents about different aspects of engaging in and conducting equity-oriented D&I research. All analyses were conducted in SPSS Version 27.0. RESULTS A total of 180 participants responded to the survey. Most participants were women (81.7%), white (66.1%), academics (78.9%), and faculty members (53.9%). Many reported they were advanced (36.7%) or advanced beginners (27.8%) in the D&I field, and a substantial proportion (37.8%) reported being novice in D&I research that focused on health equity. Participants reported high motivation (e.g., 62.8% were motivated to apply theories, models, frameworks for promoting health equity in D&I research), but low capability to conduct equity-oriented D&I research (e.g., 5% had the information needed for promoting health equity in D&I research). Most participants (62.2%) reported not having used measures to examine equity in their D&I projects, and for those who did use measures, they mainly used individual-level measures (vs. organizational- or structural-level measures). When asked about factors that could influence their ability to conduct equity-oriented D&I research, 44.4% reported not having the skills necessary, and 32.2% stated difficulties in receiving funding for equity-oriented D&I research. CONCLUSIONS Study findings provide empirical insight into the perspectives of researchers from different backgrounds on what is needed to conduct equity-oriented D&I research. These data suggest the need for a multi-pronged approach to enhance the capability and opportunities for conducting equity-oriented D&I work, such as: training specifically in equity-oriented D&I, collaboration between D&I researchers with individuals with expertise and lived experience with health equity research, funding for equity-oriented D&I research, and recognition of the value of community engaged research in promotion packages.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Eva N. Woodward
- Center for Mental Healthcare and Outcomes Research, U.S. Department of Veterans Affairs, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Rajinder Sonia Singh
- South Central Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, North Little Rock, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY USA
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Rakhra A, Hooley C, Fort M, Weber MB, Price L, Nguyen HL, Ramirez M, Muula AS, Hosseinipour M, Apusiga K, Davila-Roman V, Gyamfi J, Adjei KGA, Andesia J, Fitzpatrick A, Launois P, Baumann AA. The WHO-TDR Dissemination and Implementation Massive Open Online Course (MOOC): Evaluation and Lessons Learned from Eight Low-and Middle-Income Countries. Res Sq 2022:rs.3.rs-1455034. [PMID: 35411340 PMCID: PMC8996629 DOI: 10.21203/rs.3.rs-1455034/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in low-and middle-income countries (LMICs). Despite this, a lack of funding, training and mentorship for NCD investigators in LMICs exists. In an effort to gain knowledge and skills to address these gaps, participants from the Global Research on Implementation and Translation Science (GRIT), a consortium of studies in eight LMICs and their networks, attended the dissemination and implementation (D&I) massive open online course (MOOC) developed by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization to strengthen D&I capacity building. Here, we report on the feasibility of this MOOC, which was implemented during the SARS COVID-19 pandemic from April- November 2020. Methods Participants completed pre- and post- training questionnaires to assess self-reported D&I competencies, general research skills, and research mentor access and quality. D&I competencies were measured by use of a scale developed for a US-based training program, with change in competency scores assessed by paired t test. We used univariate statistics to analyze the data for all other outcomes. Results Of the 247 participants enrolled, 32 (13%) completed all MOOC components. D&I competency scores suggest improvement for those who had complete pre- and post-assessments. Trainee's average score on the full competency scale improved 1.45 points (0-5 scale) from pre- to post-test; all four subscales also showed evidence of improvements. There were small but not significant increases in competencies for grant writing, proposal/ manuscript writing and presentations from pre- to post-test assessment. 40% of trainees reported access to a research mentor and 12% reported access to a D&I specific mentor. Participants reported barriers (e.g., unstable internet access and challenges due to COVID-19) and facilitators (e.g., topical interests, collaboration with colleagues) to completing the MOOC. Conclusions Although COVID-19 affected program usage and completion, the MOOC was feasible and effective, showing that among LMIC participants completing the course, there was improvement in D&I competency scores. Recommendations for future D&I trainings in LMICs should include 1) adding more topic specific modules (i.e., NCD research, general research skills) for scalability; 2) fostering more collaboration with participants across LMICs; and 3) establishing partnerships with D&I mentors for course participants.
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Affiliation(s)
| | | | - Meredith Fort
- Colorado School of Public Health American Indian and Alaska Native Programs: Colorado School of Public Health Centers for American Indian and Alaska Native Health
| | - Mary Beth Weber
- Rollins School of Public Health: Emory University School of Public Health
| | | | | | - Manuel Ramirez
- Institute of Nutrition of Central America and Panama: Instituto de Nutricion de Centroamerica y Panama
| | | | | | | | | | - Joyce Gyamfi
- New York University College of Global Public Health
| | | | | | | | - Pascal Launois
- Special Programme for Research and Training in Tropical Diseases
| | - Ana A Baumann
- Washington University in St Louis Department of Surgery
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24
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Bello-Manga H, Haliru L, Ahmed KA, Tabari AM, Farouk BU, Bahago GY, Kazaure AS, Muhammad AS, Gwarzo SA, Baumann AA, DeBaun MR, King AA. Primary Prevention of Stroke in Children with Sickle Cell Anemia in Nigeria: Protocol for a Mixed-Methods Implementation Study in a Community Hospital (Preprint). JMIR Res Protoc 2022; 11:e37927. [PMID: 35700018 PMCID: PMC9496111 DOI: 10.2196/37927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Lawal Haliru
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Kudrat Abdulkareem Ahmed
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Abdulkadir Musa Tabari
- Department of Radiology, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Bilkisu Usman Farouk
- Department of Radiology, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Gloria Yimi Bahago
- Department of Nursing Services, Haematology Unit, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Aisha Shuaibu Kazaure
- Department of Pharmaceutical Services, Barau Dikko Teaching Hopsital, Kaduna, Nigeria
| | | | | | - Ana A Baumann
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Michael R DeBaun
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Allison A King
- Program in Occupational Therapy, Department of Medicine, Pediatrics, Surgery, and Education, Washington University School of Medicine, St. Louis, MO, United States
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25
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Abstract
Elvin Hsing Geng and colleagues discuss mechanism mapping and its utility in conceptualizing and understanding how implementation strategies produce desired effects.
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Affiliation(s)
- Elvin H. Geng
- Center for Dissemination and Implementation, Institute for Public Health and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ana A. Baumann
- Division of Prevention Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Byron J. Powell
- Center for Dissemination and Implementation, Institute for Public Health and Brown School, Washington University, St. Louis, Missouri, United States of America
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26
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Ghafuri DL, Abdullahi SU, Dambatta AH, Galadanci J, Tabari MA, Bello-Manga H, Idris N, Inuwa H, Tijjani A, Suleiman AA, Jibir BW, Gambo S, Gambo AI, Khalifa Y, Haliru L, Abdulrasheed S, Zakari MA, Greene BC, Trevathan E, Jordan LC, Aliyu MH, Baumann AA, DeBaun MR. Establishing Sickle Cell Disease Stroke Prevention Teams in Africa is Feasible: Program Evaluation Using the RE-AIM Framework. J Pediatr Hematol Oncol 2022; 44:e56-e61. [PMID: 34001783 PMCID: PMC8728755 DOI: 10.1097/mph.0000000000002179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team's readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program's 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program's feasibility and short-term sustainability.
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Affiliation(s)
- Djamila L. Ghafuri
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | | | | | | | | | | | | | | | | | | | | | - Safiya Gambo
- Pediatrics, Murtala Mohammed Specialist Hospital
| | | | - Yusuf Khalifa
- Department of Administration, Aminu Kano Teaching Hospital, Kano
| | - Lawal Haliru
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Sani Abdulrasheed
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | | | - Brittany C. Greene
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | - Edwin Trevathan
- Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology
| | - Muktar H. Aliyu
- Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center
| | - Ana A. Baumann
- Brown School of Social Work, Washington University of St. Louis, St. Louis, MO
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
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Smith WJ, Martin MY, Pisu M, Oster RA, Qu H, Shewchuk RM, Sheffield ME, Minter A, Baumann AA, Rogers LQ. Promoting Physical Activity in Rural Settings: Effectiveness and Potential Strategies. Transl J Am Coll Sports Med 2021; 6. [PMID: 34778552 DOI: 10.1249/tjx.0000000000000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose Implementing efficacious physical activity interventions in real-world rural settings is needed because rural cancer survivors are more physically inactive and experience poorer health. To address this gap, this study evaluated effectiveness of an evidenced-based physical activity program (Better Exercise Adherence after Treatment for Cancer [BEAT Cancer]) for rural women cancer survivors when implemented by community-based, non-research staff. Methods 16 rural women cancer survivors received BEAT Cancer implemented by a rural, community organization and non-research staff; physical activity, patient-reported outcomes, and social cognitive constructs were measured at baseline and post-program. Cancer survivors and interventionists completed program evaluations post-program. Results Cancer survivor mean age was 58±12 years; 62% were White. Mean months since diagnosis was 54±72; 69% had breast cancer. Significant improvements from pre- to post-program occurred for self-report weekly minutes of moderate-to-vigorous physical activity (mean change [M] = 146±186, p = 0.009), anxiety (M = -1.3±1.8, p = 0.016), depression (M = -2.1±2.0, p = 0.001), self-efficacy (M = 20.9±30.5, p = 0.019), barriers interference (M = -15.0±14.1, p = 0.001), and social support (M = 5.0±7.4, p = 0.02). Cancer survivors ranked the program highly, identified strategies that were helpful (e.g., group activities, personalized exercise plan, etc.), and suggested additional implementation strategies (e.g., guide for home-based phase, etc.). Interventionists identified strategies (e.g., logistics, staff training and certification, cost, etc.) for enhancing organizational readiness for program delivery. Conclusion Evidence-based physical activity programs can be effective when implemented by non-research staff in rural settings. Further research testing strategies that improve implementation is needed. Practical Implications Effectiveness and identified strategies supporting delivery when implemented by a rural organization can improve physical activity promotion for rural, at-risk populations.
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Affiliation(s)
- Whitney J Smith
- College of Medicine, University of South Alabama, Mobile, AL
| | - Michelle Y Martin
- Department of Preventive Medicine and Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, TN
| | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
| | - Richard M Shewchuk
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
| | - Laura Q Rogers
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Ademuyiwa FO, Salyer P, Tao Y, Luo J, Hensing WL, Afolalu A, Peterson LL, Weilbaecher K, Housten AJ, Baumann AA, Desai M, Jones S, Linnenbringer E, Plichta J, Bierut L. Genetic Counseling and Testing in African American Patients With Breast Cancer: A Nationwide Survey of US Breast Oncologists. J Clin Oncol 2021; 39:4020-4028. [PMID: 34662201 DOI: 10.1200/jco.21.01426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To determine if physicians' self-reported knowledge, attitudes, and practices regarding genetic counseling and testing (GCT) vary by patients' race. METHODS We conducted a nationwide 49-item survey among breast oncology physicians in the United States. We queried respondents about their own demographics, clinical characteristics, knowledge, attitudes, practices, and perceived barriers in providing GCT to patients with breast cancer. RESULTS Our survey included responses from 277 physicians (females, 58.8%; medical oncologists, 75.1%; academic physicians, 61.7%; and Whites, 67.1%). Only 1.8% indicated that they were more likely to refer a White patient than refer an African American patient for GCT, and 66.9% believed that African American women with breast cancer have lower rates of GCT than White women. Regarding perceived barriers to GCT, 63.4% of respondents indicated that African American women face more barriers than White women do and 21% felt that African American women require more information and guidance during the GCT decision-making process than White women. Although 32% of respondents indicated that lack of trust was a barrier to GCT in all patients, 58.1% felt that this was a greater barrier for African American women (P < .0001). Only 13.9% believed that noncompliance with GCT is a barrier for all patients, whereas 30.6% believed that African American women are more likely than White women to be noncompliant (P < .0001). CONCLUSION We demonstrated that racial differences exist in oncology physicians' perceived barriers to GCT for patients with breast cancer. This nationwide survey will serve as a basis for understanding physicians' determinants of GCT for African American women and highlights the necessity of education and interventions to address bias among physicians. Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved GCT equity for African American women with breast cancer.
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Affiliation(s)
- Foluso O Ademuyiwa
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Patricia Salyer
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Yu Tao
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO.,Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO
| | - Jingqin Luo
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO.,Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO
| | - Whitney L Hensing
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | | | - Lindsay L Peterson
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | | | - Ashley J Housten
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Ana A Baumann
- Brown School at Washington University in St Louis, St Louis, MO
| | - Monica Desai
- Houston Methodist Oncology Partners, Houston, TX
| | - Susan Jones
- Division of Genetics and Genomic Medicine, Washington University School of Medicine, St Louis, MO
| | - Erin Linnenbringer
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Jennifer Plichta
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
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Baumann AA, Hooley C, Goss CW, Mutabazi V, Brown AL, Schechtman KB, Twagirumukiza M, de Las Fuentes L, Reeds D, Williams M, Mutimura E, Bergström A, Nishimwe A, Ingabire C, Davila-Roman VG. Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire. BMJ Open 2021; 11:e048425. [PMID: 34548353 PMCID: PMC8458329 DOI: 10.1136/bmjopen-2020-048425] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IMPORTANCE Hypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary. OBJECTIVE To study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool. DESIGN A cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training. SETTING Three tertiary care hospitals in Rwanda. PARTICIPANTS Healthcare professionals (n=223). PRIMARY OUTCOMES AND MEASURES The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0-1 scale). Four questions surveyed training on hypertension. RESULTS Responders (n=223, 75% women; 56% aged 20-35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care. CONCLUSIONS There is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.
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Affiliation(s)
- Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, Utah, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University in St. Louis, St Louis, Missouri, USA
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marc Twagirumukiza
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa de Las Fuentes
- Washington University in St. Louis, Division of Biostatistics, St. Louis, MO, USA
- Washington University in St. Louis, School of Medicine, Cardiovascular Division, Department of Medicine, St. Louis, MO, USA
| | - Dominic Reeds
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, St. Louis, MO, USA
| | - Makeda Williams
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- National Council for Science and Technology, Kigali, Rwanda and to Regional Alliance for Sustainable Development, Kigali, Rwanda
| | - Anna Bergström
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dept of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cecile Ingabire
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA
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Yousefi Nooraie R, Lyons PG, Baumann AA, Saboury B. Equitable Implementation of Artificial Intelligence in Medical Imaging: What Can be Learned from Implementation Science? PET Clin 2021; 16:643-653. [PMID: 34537134 DOI: 10.1016/j.cpet.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Artificial intelligence (AI) has been rapidly adopted in various health care domains. Molecular imaging, accordingly, has demonstrated growing academic and commercial interest in AI. Unprepared and inequitable implementation and scale-up of AI in health care may pose challenges. Implementation of AI, as a complex intervention, may face various barriers, at individual, interindividual, organizational, health system, and community levels. To address these barriers, recommendations have been developed to consider health equity as a critical lens to sensitize implementation, engage stakeholders in implementation and evaluation, recognize and incorporate the iterative nature of implementation, and integrate equity and implementation in early-stage AI research.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, Rochester, NY 14642, USA.
| | - Patrick G Lyons
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St Louis, 660 South Euclid Avenue, MSC 8052-43-14, St. Louis, MO 63110-1010, USA; Healthcare Innovation Lab, BJC HealthCare, St Louis, MO, USA
| | - Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, 600 S. Taylor Ave, MSC:8100-0094-02, St. Louis, MO 63110, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Baltimore, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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31
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Leppin AL, Baumann AA, Fernandez ME, Rudd BN, Stevens KR, Warner DO, Kwan BM, Shelton RC. Teaching for implementation: A framework for building implementation research and practice capacity within the translational science workforce. J Clin Transl Sci 2021; 5:e147. [PMID: 34527287 PMCID: PMC8411269 DOI: 10.1017/cts.2021.809] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 12/26/2022] Open
Abstract
Implementation science offers a compelling value proposition to translational science. As such, many translational science stakeholders are seeking to recruit, teach, and train an implementation science workforce. The type of workforce that will make implementation happen consists of both implementation researchers and practitioners, yet little guidance exists on how to train such a workforce. We-members of the Advancing Dissemination and Implementation Sciences in CTSAs Working Group-present the Teaching For Implementation Framework to address this gap. We describe the differences between implementation researchers and practitioners and demonstrate what and how to teach them individually and in co-learning opportunities. We briefly comment on educational infrastructures and resources that will be helpful in furthering this type of approach.
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Affiliation(s)
- Aaron L. Leppin
- Robert E. and Patricia D. Kern Center for the Science of Healthcare Delivery and Mayo Clinic Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Ana A. Baumann
- Brown School of Social Work, Washington University of St. Louis, St. Louis, MO, USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brittany N. Rudd
- Department of Psychiatry and Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen R. Stevens
- Institute for Integration of Medicine & Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bethany M. Kwan
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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32
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Luo L, King AA, Carroll Y, Baumann AA, Brambilla D, Carpenter CR, Colla J, Gibson RW, Gollan S, Hall G, Klesges L, Kutlar A, Lyon M, Melvin CL, Norell S, Mueller M, Potter MB, Richesson R, Richardson LD, Ryan G, Siewny L, Treadwell M, Zun L, Armstrong-Brown J, Cox L, Tanabe P. Electronic Health Record-Embedded Individualized Pain Plans for Emergency Department Treatment of Vaso-occlusive Episodes in Adults With Sickle Cell Disease: Protocol for a Preimplementation and Postimplementation Study. JMIR Res Protoc 2021; 10:e24818. [PMID: 33861209 PMCID: PMC8087964 DOI: 10.2196/24818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals living with sickle cell disease often require aggressive treatment of pain associated with vaso-occlusive episodes in the emergency department. Frequently, pain relief is poor. The 2014 National Heart, Lung, and Blood Institute evidence-based guidelines recommended an individualized treatment and monitoring protocol to improve pain management of vaso-occlusive episodes. Objective This study will implement an electronic health record–embedded individualized pain plan with provider and patient access in the emergency departments of 8 US academic centers to improve pain treatment for adult patients with sickle cell disease. This study will assess the overall effects of electronic health record–embedded individualized pain plans on improving patient and provider outcomes associated with pain treatment in the emergency department setting and explore barriers and facilitators to the implementation process. Methods A preimplementation and postimplementation study is being conducted by all 8 sites that are members of the National Heart, Lung, and Blood Institute–funded Sickle Cell Disease Implementation Consortium. Adults with sickle cell disease aged 18 to 45 years who had a visit to a participating emergency department for vaso-occlusive episodes within 90 days prior to enrollment will be eligible for inclusion. Patients will be enrolled in the clinic or remotely. The target analytical sample size of this study is 160 patient participants (20 per site) who have had an emergency department visit for vaso-occlusive episode treatment at participating emergency departments during the study period. Each site is expected to enroll approximately 40 participants to reach the analytical sample size. The electronic health record–embedded individualized pain plans will be written by the patient’s sickle cell disease provider, and sites will work with the local informatics team to identify the best method to build the electronic health record–embedded individualized pain plan with patient and provider access. Each site will adopt required patient and provider implementation strategies and can choose to adopt optional strategies to improve the uptake and sustainability of the intervention. The study is informed by the Technology Acceptance Model 2 and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Provider and patient baseline survey, follow-up survey within 96 hours of an emergency department vaso-occlusive episode visit, and selected qualitative interviews within 2 weeks of an emergency department visit will be performed to assess the primary outcome, patient-perceived quality of emergency department pain treatment, and additional implementation and intervention outcomes. Electronic health record data will be used to analyze individualized pain plan adherence and additional secondary outcomes, such as hospital admission and readmission rates. Results The study is currently enrolling study participants. The active implementation period is 18 months. Conclusions This study proposes a structured, framework-informed approach to implement electronic health record–embedded individualized pain plans with both patient and provider access in routine emergency department practice. The results of the study will inform the implementation of electronic health record–embedded individualized pain plans at a larger scale outside of Sickle Cell Disease Implementation Consortium centers. Trial Registration ClinicalTrials.gov NCT04584528; https://clinicaltrials.gov/ct2/show/NCT04584528. International Registered Report Identifier (IRRID) DERR1-10.2196/24818
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Affiliation(s)
- Lingzi Luo
- Washington University School of Medicine, St Louis, MO, United States
| | - Allison A King
- Washington University School of Medicine, St Louis, MO, United States
| | - Yvonne Carroll
- St Jude Children's Research Hospital, Memphis, TN, United States
| | - Ana A Baumann
- Washington University in St. Louis, St Louis, MO, United States
| | | | | | - Joseph Colla
- University of Illinois Chicago, Chicago, IL, United States
| | | | | | - Greg Hall
- Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Klesges
- Washington University School of Medicine, St Louis, MO, United States.,University of Memphis, Memphis, TN, United States
| | | | | | - Cathy L Melvin
- Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Norell
- University of Illinois Chicago, Chicago, IL, United States
| | - Martina Mueller
- Medical University of South Carolina, Charleston, SC, United States
| | - Michael B Potter
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - Gery Ryan
- The RAND Corporation, Santa Monica, CA, United States
| | | | - Marsha Treadwell
- University of California San Francisco, San Francisco, CA, United States
| | - Leslie Zun
- Chicago Medical School, North Chicago, IL, United States
| | | | - Lisa Cox
- RTI International, Durham, NC, United States
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33
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Miller CJ, Barnett ML, Baumann AA, Gutner CA, Wiltsey-Stirman S. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare. Implement Sci 2021; 16:36. [PMID: 33827716 PMCID: PMC8024675 DOI: 10.1186/s13012-021-01105-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [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] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. DISCUSSION We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists ("think-aloud" exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. CONCLUSION Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.
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Affiliation(s)
- Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Ana A Baumann
- Washington University at St. Louis, St. Louis, MO, USA
| | - Cassidy A Gutner
- ViiV Healthcare, Innovation & Implementation Science, Research Triangle, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD Dissemination and Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Shenderovich Y, Lachman JM, Ward CL, Wessels I, Gardner F, Tomlinson M, Oliver D, Janowski R, Martin M, Okop K, Sacolo-Gwebu H, Ngcobo LL, Fang Z, Alampay L, Baban A, Baumann AA, de Barros RB, Bojo S, Butchart A, Dippenaar W, Exavery A, Fang X, Ferdinandi I, Foran HM, Heinrichs N, Hutchings J, Kisyombe D, Massetti G, Mazak J, Mbuyi H, Singh P, Polsky K, Rakotomalala S, Raleva M, Savo R, Cluver L. The Science of Scale for Violence Prevention: A New Agenda for Family Strengthening in Low- and Middle-Income Countries. Front Public Health 2021; 9:581440. [PMID: 33869123 PMCID: PMC8044965 DOI: 10.3389/fpubh.2021.581440] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.
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Affiliation(s)
- Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Catherine L. Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Inge Wessels
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Daniel Oliver
- Catholic Relief Services, Baltimore, MD, United States
| | - Roselinde Janowski
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Mackenzie Martin
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Kufre Okop
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | | | - Zuyi Fang
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Liane Alampay
- Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Ana A. Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Samuel Bojo
- Agency for Research and Development Initiative, Juba, South Sudan
| | - Alexander Butchart
- Department of Injury and Violence Prevention, World Health Organization, Geneva, Switzerland
| | | | | | - Xiangming Fang
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | | | - Heather M. Foran
- Institute for Psychology, Universitat Klagenfurt, Klagenfurt, Austria
| | - Nina Heinrichs
- Department of Psychology, University of Bremen, Bremen, Germany
| | - Judy Hutchings
- School of Psychology, Bangor University, Bangor, United Kingdom
| | | | - Greta Massetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jaromir Mazak
- Schola Empirica, Prague, Czechia
- Faculty of Arts, Charles University, Prague, Czechia
| | - Henry Mbuyi
- Catholic Relief Services DRC, Gombe, Democratic Republic of Congo
| | | | | | - Sabine Rakotomalala
- Global Partnership to End Violence Against Children, World Health Organization, Geneva, Switzerland
| | - Marija Raleva
- Department of Child and Adolescent Psychiatry, St. Cyril and Methodius University Skopje, Skopje, Macedonia
| | - Richard Savo
- Catholic Relief Services Zimbabwe, Harare, Zimbabwe
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Adams JL, Martin MY, Pisu M, Oster RA, Qu H, Shewchuk RM, Sheffield ME, Minter A, Baumann AA, Rogers LQ. Determining patient needs to enhance exercise program implementation and uptake in rural settings for women after a cancer diagnosis. Support Care Cancer 2021; 29:4641-4649. [PMID: 33495849 DOI: 10.1007/s00520-021-05990-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/19/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To qualitatively explore exercise barriers and facilitators experienced by rural female cancer survivors from the program interventionist and recipient perspective for the purpose of enhancing exercise program implementation and uptake in rural settings. METHODS A descriptive qualitative study design was utilized. Focus groups were conducted prior to implementation of an evidence-based exercise program by a rural non-research cancer clinical site. Nineteen rural female cancer survivors (mean age = 61.7 ± 10.9 years) and 11 potential interventionists (mean age = 42.3 ± 15.3 years) completed focus groups (stratified by participant role). Focus groups were audio recorded, transcribed, coded, and analyzed using inductive thematic analysis with NVivo 11. RESULTS Cancer survivors identified 12 barrier themes (cancer specific adverse effects, lack of support, lack of knowledge, perceived negative aspects of exercise, cost, lack of resources, motivation, inconvenience, lack of program flexibility, time, weather, safety) and eight facilitator themes (knowledge, ease of access, resources, awareness, cost, options, organized, fun) related to exercise. Interventionists identified seven barrier themes (cost, transportation, lack of cancer survivor and interventionist knowledge, fear, motivation, lack of support, lack of resources) and four facilitator themes (resources, support, knowledge, motivation). Narratives revealed differing role-specific perspectives on shared themes between survivors and interventionists as well as potential implementation strategies for enhancing exercise participation and exercise program uptake among rural female cancer survivors. CONCLUSION Exploring multi-level stakeholder perspectives on cancer survivors' exercise needs and related strategies yields important information for organizations to consider when implementing exercise programs in rural contexts.
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Affiliation(s)
- Jessica L Adams
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | | | - Maria Pisu
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Robert A Oster
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Haiyan Qu
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Richard M Shewchuk
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | | | - Alex Minter
- Russell Medical Center, Alexander City, AL, USA
| | - Ana A Baumann
- Washington University in Saint Louis, Saint Louis, MO, USA
| | - Laura Q Rogers
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Qu H, Shewchuk R, Hu X, Baumann AA, Martin MY, Pisu M, Oster RA, Rogers LQ. Input from multiple stakeholder levels prioritizes targets for improving implementation of an exercise intervention for rural women cancer survivors. Implement Sci Commun 2020; 1:97. [PMID: 33292813 PMCID: PMC7640400 DOI: 10.1186/s43058-020-00061-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although evidence-based interventions for increasing exercise among cancer survivors (CSs) exist, little is known about factors (e.g., implementation facilitators) that increase effectiveness and reach of such interventions, especially in rural settings. Such factors can be used to design implementation strategies. Hence, our study purpose was to (1) obtain multilevel perspectives on improving participation in and implementation of a multicomponent exercise behavior change intervention for rural women CSs and (2) identify factors important for understanding the context using the Consolidated Framework for Implementation Research (CFIR) for comparison across three levels (CSs, potential interventionists, community/organizational stakeholders). Methods We conducted three nominal group technique meetings with rural women CSs, three with community/organizational stakeholders, and one with potential interventionists. During each meeting, participants were asked to respond silently to one question asking what would make a multicomponent exercise intervention doable from intervention participation (CSs) or implementation (potential interventionists, stakeholders) perspectives. Responses were shared, discussed to clarify meaning, and prioritized by group vote. Data was deductively coded using CFIR. Results Mean age of CSs (n = 19) was 61.8 ± 11.1 years, community stakeholders (n = 16) was 45.9 ± 8.1 years, and potential interventionists (n = 7) was 41.7 ± 15.2 years. There was considerable consensus among CSs, potential interventionists, and stakeholders in terms of CFIR domains and constructs, e.g., “Design quality and packaging” (Innovation Characteristics), “Patients needs and resources” (Outer Setting), “Available resources” (Inner Setting), and “Engaging” (Process). However, participant-specific CFIR domains and constructs were also observed, e.g., CSs endorsed “Knowledge and beliefs about the intervention,” “Individual stage of change,” and “Self-efficacy” (Characteristics of Individuals); potential interventionists valued “Tension for change” (Inner Setting) and “Innovation participants” and “Key stakeholder” (Process); stakeholders emphasized “Goals and feedback” and “Network and communication” (Inner Setting), and “Planning” (Process). How the three participant levels conceptualized the CFIR constructs demonstrated both similarities and differences. Conclusions Multilevel input yielded diversity in type, relative priority, and conceptualization of implementation facilitators suggesting foci for future implementation strategy development and testing. Findings also reinforced the importance of multilevel implementation strategies for increasing exercise in an underserved, at-risk population.
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Affiliation(s)
- Haiyan Qu
- University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35294, USA
| | - Richard Shewchuk
- University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35294, USA
| | - Xuejun Hu
- University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35294, USA
| | - Ana A Baumann
- Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Michelle Y Martin
- Department of Preventive Medicine and Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Maria Pisu
- School of Medicine, Division of Preventive Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Ave S, MT 636, Birmingham, AL, 35294-4410, USA
| | - Robert A Oster
- School of Medicine, Division of Preventive Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Ave S, MT 642, Birmingham, AL, 35294-4410, USA
| | - Laura Q Rogers
- School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 614, Birmingham, AL, 35294-4410, USA.
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Abraham J, Meng A, Siraco S, Kannampallil T, Politi MC, Baumann AA, Lenze EJ, Avidan MS. A Qualitative Study of Perioperative Depression and Anxiety in Older Adults. Am J Geriatr Psychiatry 2020; 28:1107-1118. [PMID: 32234274 DOI: 10.1016/j.jagp.2020.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care. DESIGN A qualitative study using semistructured interviews was conducted. SETTING Participants were recruited at a large academic medical center. PARTICIPANTS We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs. MEASUREMENTS We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses. RESULTS Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. CONCLUSION New care models need to be developed to integrate mental health care into the current perioperative care practice.
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Affiliation(s)
- Joanna Abraham
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO.
| | - Alicia Meng
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
| | - Susan Siraco
- School of Medicine, St. Louis University (SS), St. Louis, MO
| | - Thomas Kannampallil
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery (MCP), School of Medicine, Washington University, St. Louis, MO
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University (AAB), St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EJL), School of Medicine, Washington University, St. Louis, MO
| | - Michael S Avidan
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
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Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, Mettert KD, Dorsey CN, Purtle J, Kepper MM, Baumann AA, Brownson RC. Quantitative measures of health policy implementation determinants and outcomes: a systematic review. Implement Sci 2020; 15:47. [PMID: 32560661 PMCID: PMC7304175 DOI: 10.1186/s13012-020-01007-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. METHODS Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. RESULTS Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. CONCLUSIONS Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health. REGISTRATION Not registered.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, 2190 FJSB, Provo, UT, 84602, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Kayne D Mettert
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Maura M Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Ana A Baumann
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4921 Parkview Place, Saint Louis, MO, 63110, USA
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Baumann AA. Commentary: Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries. Front Public Health 2020; 8:218. [PMID: 32582613 PMCID: PMC7297202 DOI: 10.3389/fpubh.2020.00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ana A. Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
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Hooley C, Baumann AA, Mutabazi V, Brown A, Reeds D, Cade WT, Fuentes LDL, Proctor EK, Karengera S, Schecthman K, Goss C, Launois P, Davila-Roman VG, Mutimura E. The TDR MOOC training in implementation research: evaluation of feasibility and lessons learned in Rwanda. Pilot Feasibility Stud 2020; 6:66. [PMID: 32467769 PMCID: PMC7229620 DOI: 10.1186/s40814-020-00607-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension (HTN) affects nearly 1 billion people globally and is a major cause of morbidity and mortality. In low- and middle-income countries (LMICs), HTN represents an unmet health care gap that can be addressed by strengthening national health care systems. The National Heart, Lung, and Blood Institute recently funded the T4 Translation Research Capacity Building Initiative in Low Income Countries (TREIN) program to build capacity in dissemination and implementation (D&I) research in HTN in LMICs. The Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) recently developed a massive open online course (MOOC) to train in D&I. Herein, we report on the use of the TDR WHO MOOC in D&I for the TREIN program in Rwanda, assessing feasibility of the MOOC and D&I competencies after MOOC training. Methods Participants in one-group MOOC training completed pre- and post-training questionnaires to assess dissemination and implementation (D&I) competency outcomes and feasibility. D&I competencies were measured by use of a scale developed for a US-based training program, with the change in competency scores assessed by paired t test. Feasibility was measured by completion of homework and final project assignment and analyzed using descriptive statistics. Results Of the 92 trainees enrolled, 35 (38%) completed all MOOC components. D&I competency scores showed strong evidence of improvements from pre- to post-test. The full-scale average score improved by an average of 1.09 points, representing an effect size of 1.25 (CI 0.48-2.00); all four subscales also showed strong evidence of improvements. Trainees reported challenges to MOOC course completion that included technological issues (i.e., limited internet access) and competing demands (i.e., work, family). Conclusions In the context of LMIC training, the MOOC course was feasible and course completion showed improvement in D&I competency scores. While the program was designed with a focus on training for tropical diseases, there is potential for scalability to a wider audience of health care researchers, workers, administrators, and policymakers in LMIC interested in D&I research in non-communicable diseases.
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Affiliation(s)
- Cole Hooley
- 1Brown School of Social Work, WUSTL, St. Louis, MO USA
| | - Ana A Baumann
- 1Brown School of Social Work, WUSTL, St. Louis, MO USA
| | - Vincent Mutabazi
- 2Regional Alliance for Sustainable Development (RASD) Rwanda, Kigali, Rwanda
| | - Angela Brown
- 3Cardiovascular Division, WUSTL, St. Louis, MO USA
| | - Dominic Reeds
- 4Division of Geriatrics and Nutritional Science, WUSTL, St. Louis, MO USA
| | - W Todd Cade
- 5Program in Physical Therapy, WUSTL, St. Louis, MO USA
| | | | | | - Stephen Karengera
- 2Regional Alliance for Sustainable Development (RASD) Rwanda, Kigali, Rwanda
| | | | - Charles Goss
- 6Division of Biostatistics, WUSTL, St. Louis, MO USA
| | - Pascal Launois
- 7Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | | | - Eugene Mutimura
- 2Regional Alliance for Sustainable Development (RASD) Rwanda, Kigali, Rwanda
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Miller CJ, Wiltsey-Stirman S, Baumann AA. Iterative Decision-making for Evaluation of Adaptations (IDEA): A decision tree for balancing adaptation, fidelity, and intervention impact. J Community Psychol 2020; 48:1163-1177. [PMID: 31970812 PMCID: PMC7261620 DOI: 10.1002/jcop.22279] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 05/17/2023]
Abstract
BACKGROUND Evidence-based practices (EBPs) are frequently adapted to maximize outcomes while maintaining fidelity to core EBP elements. Many step-by-step frameworks for adapting EBPs have been developed, but these models may not account for common complexities in the adaptation process. In this paper, we introduce the Iterative Decision-making for Evaluation of Adaptations (IDEA), a tool to guide adaptations that addresses these issues. FRAMEWORK DESIGN AND USE Adapting EBPs requires attending to key contingencies incorporated into the IDEA, including: the need for adaptations; fidelity to core EBP elements; the timeframe in which to make adaptations; the potential to collect pilot data; key clinical and implementation outcomes; and stakeholder viewpoints. We use two examples to illustrate application of the IDEA. CONCLUSIONS The IDEA is a practical tool to guide EBP adaptation that incorporates important decision points and the dynamism of ongoing adaptation. Its use may help implementation scientists, clinicians, and administrators maximize EBP impact.
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Affiliation(s)
- Christopher J Miller
- Department of Psychiatry, VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Harvard Medical School, Boston, Massachusetts
| | - Shannon Wiltsey-Stirman
- Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System, National Center for PTSD Dissemination and Training Division, Stanford University, Stanford, California
| | - Ana A Baumann
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Abstract
BACKGROUND Research has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery. MAIN TEXT Using Proctor et al.' (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes. CONCLUSIONS The goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.
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Affiliation(s)
- Ana A. Baumann
- Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | - Leopoldo J. Cabassa
- Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
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Baumann AA, Carothers BJ, Landsverk J, Kryzer E, Aarons GA, Brownson RC, Glisson C, Mittman B, Proctor EK. Evaluation of the Implementation Research Institute: Trainees' Publications and Grant Productivity. Adm Policy Ment Health 2020; 47:254-264. [PMID: 31667667 PMCID: PMC7285898 DOI: 10.1007/s10488-019-00977-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With growth in the field of dissemination and implementation (D&I) research, there has been growth in capacity building, with many training opportunities. As such, it is important to continue to evaluate D&I research training programs. This paper reports the results of an evaluation of the Implementation Research Institute (IRI), a R25 funded by the National Institute of Mental Health with additional funding by the Department of Veterans Affairs (VA). The fourth cohort also had a supplement from the National Institute on Drug Abuse. Using bibliometrics data, we report on a quasi-experimental retrospective cohort study assessing whether the rates of scholarly productivity in D&I science of IRI fellows (those who applied and were accepted to the training) were greater than those who applied but were not accepted to IRI. Our findings show that Selected Applicants' odds of publishing in implementation science were higher for earlier alumni, starting at 12% 1 year out and increasing to 94% for those who were 4 years out from starting training. Chances for Non-Selected Applicants remained relatively stable, starting at 47% at 1 year and going to 33% at 4 years since their application, a pattern that was stable even after controlling for demographic characteristics. These results support the hypothesis that IRI is increasing the D&I research productivity of those selected to the program, and that our fellows are advancing the field of D&I compared to those investigators not selected to our institute. Our finding also indicates the importance of a 2-year training.
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Affiliation(s)
- Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Bobbi J Carothers
- Center for Public Health Systems Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - John Landsverk
- Oregon Social Learning Center, 10 Shelton Mcmurphey Blvd, Eugene, OR, 97401, USA
| | - Emily Kryzer
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center (CASRC), UC San Diego, 9500 Gilmar Drive 0812, La Jolla, CA, 92093-0812, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Charles Glisson
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee, Knoxville, 1618 W. Cumberland Ave, 201 Henson Hall, Knoxville, TN, 37996-332, USA
| | - Brian Mittman
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles Ave, Pasadena, CA, 91101-2453, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
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Baumann AA, Mejia A, Lachman JM, Parra Cardona JR, López-Zerón G, Amador Buenabad NG, Vargas E, Domenech Rodríguez MM. Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice. Glob Soc Welf 2019; 6:199-207. [PMID: 32095423 PMCID: PMC7036747 DOI: 10.1007/s40609-018-0121-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.
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Affiliation(s)
| | - Anilena Mejia
- Instituto de Investigaciones Científicas y Servicios de Alta
Tecnología (INDICASAT)
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Leppin AL, Mahoney JE, Stevens KR, Bartels SJ, Baldwin LM, Dolor RJ, Proctor EK, Scholl L, Moore JB, Baumann AA, Rohweder CL, Luby J, Meissner P. Situating dissemination and implementation sciences within and across the translational research spectrum. J Clin Transl Sci 2019; 4:152-158. [PMID: 32695482 PMCID: PMC7348034 DOI: 10.1017/cts.2019.392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022] Open
Abstract
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework's major proposition is that it situates D&I sciences as targeted "sub-sciences" of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
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Affiliation(s)
- Aaron L. Leppin
- Department of Health Sciences Research, Mayo Clinic, Mayo Clinic Center for Clinical and Translational Science, Rochester, MN, USA
| | - Jane E. Mahoney
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kathleen R. Stevens
- Department of Nursing, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | | | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | | | - Enola K. Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Scholl
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Justin B. Moore
- Department of Family and Community Medicine, Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ana A. Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Catherine L. Rohweder
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Baumann AA, Domenech Rodríguez MM, Wieling E, Parra-Cardona JR, Rains LA, Forgatch MS. Teaching GenerationPMTO, an evidence-based parent intervention, in a university setting using a blended learning strategy. Pilot Feasibility Stud 2019; 5:91. [PMID: 31338206 PMCID: PMC6626357 DOI: 10.1186/s40814-019-0476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 07/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. METHODS We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. RESULTS Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = - 23.48, 95% CI = - 29.62, - 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7-9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. CONCLUSIONS BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.
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Affiliation(s)
- Ana A. Baumann
- George Warren Brown School of Social Work, Washington University, St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | | | - Elizabeth Wieling
- Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Circle, St. Paul, MN 55108 USA
| | - J. Rubén Parra-Cardona
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd 3.130F. STOP D3500, Austin, TX 78712-0358 USA
| | - Laura A. Rains
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
| | - Marion S. Forgatch
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
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Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci 2019; 14:58. [PMID: 31171014 PMCID: PMC6554895 DOI: 10.1186/s13012-019-0898-y] [Citation(s) in RCA: 478] [Impact Index Per Article: 95.6] [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: 11/19/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. Discussion We employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.’s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies. Conclusion The updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA, 94025, USA.
| | - Ana A Baumann
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR),VA Boston Healthcare System, Boston, MA, 02130, USA.,Harvard Medical School Department of Psychiatry, Boston, MA, 02115, USA
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Baumann AA, Mutabazi V, Brown AL, Hooley C, Reeds D, Ingabire C, Ndahindwa V, Nishimwe A, Cade WT, de Las Fuentes L, Proctor EK, Karengera S, Schecthman KB, Goss CW, Yarasheski K, Newsome B, Mutimura E, Davila-Roman VG. Dissemination and Implementation Program in Hypertension in Rwanda: Report on Initial Training and Evaluation. Glob Heart 2019; 14:135-141. [PMID: 31324367 PMCID: PMC6816501 DOI: 10.1016/j.gheart.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide and in low- and middle-income countries, and hypertension (HTN) is a major risk factor for CVD. Although effective evidence-based interventions for control of HTN in high-income countries exist, implementation of these in low- and middle-income countries has been challenging due to limited capacity and infrastructure for late-phase translational research. In Rwanda, the 2015 STEPS NCD (STEPwise Approach to Surveillance of Noncommunicable Diseases) risk survey reported an overall prevalence of HTN of 15% (95% confidence interval [CI]: 13.8 to 16.3) for those ages 15 to 64 years; prevalence increased with increasing age to 39% (95% CI: 35.7 to 43.1) for those ages 55 to 64 years; CVD was the third most common cause of mortality (7%). Suboptimal infrastructure and capacity in Rwanda hinders research and community knowledge for HTN control. OBJECTIVES To address the issue of suboptimal capacity to implement evidence-based interventions in HTN, this project was designed with the following objectives: 1) to develop a regional needs assessment of infrastructure for dissemination and implementation (D & I) strategies for HTN-CVD control; 2) to develop HTN-CVD research capacity through creation of countrywide resources such as core research facilities and training in the fields of HTN-CVD, D & I, and biostatistics; and 3) to engage and train multiple stakeholders in D & I and HTN-CVD evidence-based interventions. METHODS A weeklong training program in HTN-CVD, biostatistics, and D & I was conducted in Rwanda in August 2018, and pre- and post-D & I training competency questionnaires were administered. RESULTS Questionnaire results show a statistically significant increase in D & I knowledge and skills as a result of training (full scale pre- to post-test scores: 2.12 ± 0.78 vs. 3.94 ± 0.42; p < 0.0001). CONCLUSIONS Using principles of community engagement and train-the-trainer methods, we will continue to adapt guidelines and treatments for HTN-CVD developed in high-income countries to the context of Rwanda with the goal of establishing a sustainable platform to address the burden of disease from HTN-CVD.
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Affiliation(s)
- Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Angela L Brown
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Cole Hooley
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Dominic Reeds
- Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
| | - Cecile Ingabire
- School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
| | - Vedaste Ndahindwa
- School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
| | - Aurore Nishimwe
- School of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa de Las Fuentes
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA; Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephen Karengera
- Regional Alliance for Sustainable Development, Kigali, Rwanda; EAC RCE-VIHSCM, College of Medicine and Heath Sciences, University of Rwanda, Kigali, Rwanda
| | - Kenneth B Schecthman
- Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles W Goss
- Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Brad Newsome
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development, Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA.
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DiMartino LD, Baumann AA, Hsu LL, Kanter J, Gordeuk VR, Glassberg J, Treadwell MJ, Melvin CL, Telfair J, Klesges LM, King A, Wun T, Shah N, Gibson RW, Hankins JS. The sickle cell disease implementation consortium: Translating evidence-based guidelines into practice for sickle cell disease. Am J Hematol 2018; 93:E391-E395. [PMID: 30203558 PMCID: PMC6503654 DOI: 10.1002/ajh.25282] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Lewis L Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Julie Kanter
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Victor R Gordeuk
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marsha J Treadwell
- University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Telfair
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
| | - Lisa M Klesges
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Allison King
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Ted Wun
- University of California, Davis School of Medicine, Sacramento, California
| | - Nirmish Shah
- Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Robert W Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Parra-Cardona R, Leijten P, Lachman JM, Mejía A, Baumann AA, Amador Buenabad NG, Cluver L, Doubt J, Gardner F, Hutchings J, Ward CL, Wessels IM, Calam R, Chavira V, Domenech Rodríguez MM. Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities. Prev Sci 2018; 22:7-17. [PMID: 30058025 DOI: 10.1007/s11121-018-0935-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.
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Affiliation(s)
- Rubén Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., Stop, D3500, Austin, TX, 78712, USA.
| | - Patty Leijten
- Research Institute of Child Development and Education & Research Priority Area YIELD, University of Amsterdam, Amsterdam, Netherlands
| | - Jamie M Lachman
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Complexity in Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anilena Mejía
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jenny Doubt
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Department of Psychology, Bangor University, Bangor, UK
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Inge M Wessels
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Rachel Calam
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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