5,844 results on '"Implementation research"'
Search Results
2. Strengthening facility-based integrated emergency care services for time sensitive emergencies at all levels of healthcare in India: An implementation research study protocol.
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Sinha, Tej Prakash, Bhoi, Sanjeev, Sharma, Dolly, Chauhan, Sushmita, Magan, Radhika, Sahu, Ankit Kumar, Bhargava, Stuti, Nayar, Patanjali Dev, Kannan, Venkatnarayan, Lodha, Rakesh, Kacchawa, Garima, Arora, Narendra Kumar, Jini, Moji, Sinha, Pramod Kumar, Verma, Satyajeet, Goyal, Pawan, Viswanathan, K. V., Padu, Kemba, Boro, Pallavi, and Kumar, Yogesh
- Abstract
Background: The healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes. Methods: We will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model "Zero", co-implementation, model optimization, end-line evaluation and consolidation phase. The "preparatory phase" will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The "formative assessment" will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The "co-design of Model 'Zero'" phase will help develop the initial Model "Zero", which will be pilot tested on a small scale (co-implementation). In the "model optimization" phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions. Discussion: In a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy.
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Scholten, Saskia, Schemer, Lea, Herzog, Philipp, Haas, Julia W., Heider, Jens, Winter, Dorina, Reis, Dorota, and Glombiewski, Julia Anna
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PSYCHOTHERAPIST-patient relations , *ECOLOGICAL momentary assessments (Clinical psychology) , *PSYCHOTHERAPY , *EXPERIMENTAL design , *RESEARCH implementation - Abstract
Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Evaluating the Barriers and Facilitators to Implementing a Novel Referral System for Outpatient Geriatric Services: The Geri-Hub Quality Improvement Initiative.
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Lim Fat, Guillaume, Kokorelias, Kristina M, Foronda, Erica, Sadasivan, Bindhu, and Romanovsky, Lindy
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Background: In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services. Objectives: This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized "Geri-Hub." The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner. Methods: Qualitative insights were gathered from healthcare professionals at 2 academic institutions in the process of consolidating services. Through open-ended surveys and semi-structured interviews, we solicited feedback on referral management, waiting times, and overall work experiences. Results: Thirteen frequently referring providers and a cohort of 9 geriatricians, along with 4 administrators, contributed to the study. Geriatricians emphasized streamlined referrals, flexible scheduling for urgent cases, and a target wait time of 3 months. Administrators stressed standardized referral procedures, defined roles, and accessible referral information. Discussion: The findings underscored the need for straightforward referral processes, enhanced communication on referral statuses, and reduced wait times. Optimizing these processes could potentially mitigate resource utilization issues and improve patient outcomes in healthcare systems. This research highlights the critical role of timely access to geriatric services during transformative phases in healthcare delivery. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Evaluating the implementation of a hypertension program based on mHealth and community pharmacies integration to primary care centers at a municipality level in Argentina during the COVID-19 pandemic.
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Esandi, M. E., Ortiz, Z., Bernabei, V., Villalba, N. B., Liggio, S., Della Maggiora, M., García, N. A., Bruzzone, A., Blanco, G., Prieto Merino, D., Legido Quigley, H., and Perel, P.
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HEALTH services accessibility ,PATIENT compliance ,HUMAN services programs ,RESEARCH funding ,PHYSIOLOGICAL adaptation ,EVALUATION of human services programs ,HYPERTENSION ,PRIMARY health care ,INTERVIEWING ,STATISTICAL sampling ,MULTIVARIATE analysis ,DESCRIPTIVE statistics ,TELEMEDICINE ,LONGITUDINAL method ,THEMATIC analysis ,RESEARCH methodology ,MATHEMATICAL models ,DIASTOLIC blood pressure ,DRUGSTORES ,THEORY ,BLOOD pressure ,HEALTH information systems ,SYSTOLIC blood pressure ,DATA analysis software ,COVID-19 pandemic - Abstract
Introduction: While pharmacists-led interventions in hypertension have proven effective in high-income countries, their implementation and impact in lowand middle-income countries (LMIC) remain limited. This study assessed the implementation and outcomes of the hypertension program FarmaTeCuida (FTC), which integrated community pharmacies into the public primary care level using information and communication technologies. The study took place during the pandemic in General Pueyrredón, Buenos Aires, Argentina, so modifications to the implementation strategy and expected outcomes were also analyzed. Methods: A mixed-methods study was conducted using the non-adoption, abandonment, scaling-up, dissemination, and sustainability (NASSS) conceptual model. Qualitative in-depth interviews were conducted with key stakeholders using snowball sampling until thematic saturation was achieved. The quantitative approach employed a quasi-experimental, prospective, longitudinal design in a cohort of hypertensive patients enrolled in the FTC program since October 2020 to March 2022. Adoption, access, adherence to follow-up, and blood pressure levels were assessed. Clinical outcomes were compared to a cohort of hypertensive patients attending primary health care centers (PHCCs) in 2021 but not enrolled in the FTC program. Routine data from this cohort was obtained from the municipal health information system (HIS). Results: Out of 33 PHCCs, 23 adopted the FTC program, but only four collaborated with community pharmacies. A total of 440 patients were recruited, with 399 (91%) enrolled at PHCCs. Hypertensionwas detected in 63%(279/440) of cases at the first visit (113were possible hypertensive patients; 26 newhypertensive patients and 140 already diagnosed). During follow-up, FTC identified 52 new hypertensive patients (12% out of 440). Reduction of systolic blood pressure (SBP) was observed in patients enrolled in both the FTC programand the comparison group over 60 days. In themultivariate analysis that included all hypertensive patient (FTC and HIS)we found strong evidence that for each month of follow up, SBP was reduced by 1.12 mmHg; however, we did not find any significant effect of the FTC program on SBP trend (interaction FTC*months has a p-value = 0.23). The pandemic was identified as the main reason for the program's underperformance; in addition we identified barriers related to technology, patient suitability, implementation team characteristics, and organizational factors. Discussion: Our study, grounded in the NASSS model, highlights the profound complexity of introducing innovative strategies in low- and middle-income settings. Despite substantial challenges posed by the pandemic, these obstacles provided valuable insights, identified areas for improvement, and informed strategies essential for reshaping the care paradigm for conditions like hypertension in resource-constrained environments. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review.
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Neel, Abigail H., Olateju, Adetoun, Peters, Michael A., Schleiff, Meike, and Alonge, Olakunle
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MIDDLE-income countries ,HUMAN services programs ,RESEARCH funding ,DISEASE eradication ,MEDICAL care ,SOCIOECONOMIC factors ,WORLD health ,SYSTEMATIC reviews ,MEDLINE ,DISEASES ,PATIENT-centered care ,CONCEPTUAL structures ,LITERATURE reviews ,ADULT education workshops ,POLIO ,HEALTH outcome assessment ,ONLINE information services ,POLIOMYELITIS vaccines ,HEALTH promotion ,LOW-income countries ,INTER-observer reliability - Abstract
Introduction: There is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings. Methods: We nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact). Results: 152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated. Conclusions: This review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Paediatric schistosomiasis: last mile preparations for deploying paediatric praziquantel.
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Mutapi, Francisca, Garba, Amadou, Woolhouse, Mark, and Kazyoba, Paul
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PARASITIC diseases , *SCHOOL children , *ROAD maps , *SCHISTOSOMIASIS , *DRUG accessibility - Abstract
The World Health Organization (WHO) recently prequalified a new dispersible and more palatable paediatric formulation of the antischistosome drug praziquantel (PZQ). Now there is a need for implementation research to address current scientific evidence, tools, and operational strategy gaps to facilitate its deployment. Endemic countries need strategies and road maps for accessing, delivering, and scaling up adoption of this new formulation. Schistosomiasis is the second most important parasitic disease of public health importance in Africa, affecting over 50 million children aged < 5 years old. Schistosomiasis control has focused on treating school-aged children (>6 years) and adults through mass drug administration (MDA). Following the recent development of a paediatric praziquantel (PZQ) formulation for children aged <5 years, there are now concerted efforts to determine optimal and effective ways to integrate treatment of these children into national schistosomiasis control programmes. In this opinion article we outline the pathway for successful drug access, delivery, and mainstreaming of the new formulation in endemic country health systems. Effective and sustained paediatric schistosomiasis treatment is an important target of the 2030 World Health Organization (WHO) neglected tropical diseases (NTDs) roadmap. Schistosomiasis is the second most important parasitic disease of public health importance in Africa, affecting over 50 million children aged < 5 years old. Schistosomiasis control has focused on treating school-aged children (≥6 years) and adults through mass drug administration (MDA). Following the recent development of a paediatric praziquantel (PZQ) formulation for children aged <5 years, there are now concerted efforts to determine optimal and effective ways to integrate treatment of these children into national schistosomiasis control programmes. In this opinion article we outline the pathway for successful drug access, delivery, and mainstreaming of the new formulation in endemic country health systems. Effective and sustained paediatric schistosomiasis treatment is an important target of the 2030 World Health Organization (WHO) neglected tropical diseases (NTDs) roadmap. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Implementing a Population-Based Social Determinants of Health Intervention: Early Lessons Learned from Collaboration between Clinical and Community Organizations.
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Wu, Katherine
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COMMUNITY health services ,HEALTH services accessibility ,DIGITAL technology ,COMMUNITY support ,SOCIAL determinants of health ,INTERPROFESSIONAL relations ,HUMAN services programs ,MEETINGS ,EVALUATION of human services programs ,INTERVIEWING ,RESEARCH methodology ,STAKEHOLDER analysis ,MEDICAID ,MEDICAL screening ,MEDICAL referrals - Abstract
The purpose of this study was to understand the barriers and facilitators among diverse health care and community organization stakeholders implementing a populationbased social determinants of health (SDOH) intervention. The SDOH intervention included three core programs: SDOH screening, a community health worker program, and a digital referral platform. After one year of implementation, we conducted semi-structured qualitative interviews with clinical and community-based organization stakeholders about (1) the three SDOH programs, (2) organizational implementation strategies, (3) interactions with partner organizations, and (4) perceived target population needs. Findings from the first year of implementation highlighted several factors to consider when designing and implementing SDOH programming, including (1) the successful features of the three SDOH programs, (2) the local implementation strategies and challenges across organizations, (3) the impact of broader community needs and resource availability on implementation, and (4) the importance of intentionally fostering relationships and collaboration among partner organizations. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Designing an implementation science clinical trial to integrate hypertension and cardiovascular diseases care into existing HIV services package in Botswana (InterCARE).
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Youssouf, Nabila, Mogaetsho, Gaone Edwin, Moshomo, Thato, Gaolathe, Tendani, Ponatshego, Ponego, Ramotsababa, Mareko, Molefe-Baikai, Onkabetse Julia, Dintwa, Evelyn, Kiki, Tsaone, Van Pelt, Amelia E., Steger-May, Karen, Bogart, Laura M., Jaffar, Shabbar, Gala, Pooja, Wang, Duolao, Seipone, Khumo, Bennett, Kara, Hurwitz, Kathleen Wirth, Kebotsamang, Kago, and Hirschhorn, Lisa R.
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HIV , *CLUSTER randomized controlled trials , *DESIGN science , *CARDIOVASCULAR diseases , *CLINICAL trials , *ELECTRONIC health records - Abstract
Background: Despite success in HIV treatment, diagnosis and management of hypertension (HTN) and cardiovascular disease (CVD) remains suboptimal among people living with HIV (PLWH) in Botswana, with an overall HTN control of only 19% compared to 98% HIV viral suppressed. These gaps persist despite CVD primary care national guidelines and availability of free healthcare including antihypertensive medications. Our study aims to develop and test strategies to close the HTN care gap in PLWH, through integration into HIV care, leveraging the successful national HIV care and treatment program and strategies. Methods: The InterCARE trial is a cluster randomized controlled hybrid type 2 effectiveness-implementation trial at 14 sites designed to enroll 4652 adults living with HIV and HTN plus up to 2326 treatment partners. Primary outcomes included effectiveness (HTN control) and implementation outcomes using the Reach Effectiveness Adoption Implementation and Maintenance framework, with explanatory mixed methods used to understand variability in outcomes. InterCARE trial's main strategies include healthcare worker HTN and CVD care training plus long-term practice facilitation, electronic health record (EHR) documentation of key indicators and use of reminders, and use of treatment partners to provide social support to people living with HIV and HTN. InterCARE started with formative research to identify contextual factors influencing care gaps using the Consolidated Framework for Implementation Research. Results were used to adapt initial and develop additional implementation strategies to address barriers and leverage facilitators. The package was pilot tested in two clinics, with findings used to further adapt or add strategies for the clinical trial. Discussion: If successful, the InterCARE model can be scaled up to HIV clinics nationwide to improve diagnosis, management, and support in Botswana. The trial will provide insights for scale-up of HTN integration into HIV care in the region. Trial registration: ClinicalTrials.gov reference NCT05414526. Registered 18 May 2022, https://clinicaltrials.gov/study/NCT05414526?term=NCT05414526.&rank=1. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy.
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Mamo, Yoseph, Mekoro, Mirchaye, Phillips, David I. W., and Mortimore, Andrew
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NON-communicable diseases , *EPILEPSY , *HEALTH education , *MEDICAL equipment , *CONSCIOUSNESS raising , *RESPIRATORY diseases , *PATIENT-centered medical homes , *RURAL health clinics - Abstract
Background: Although primary care models for the care of common non-communicable diseases (NCD) have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. We report the results of a four-year, Ethiopian project to expand this model of NCD care to 15 primary hospitals and 45 health centres encompassing a wide geographical spread and serving a population of approximately 7.5 million people. Methods: Following baseline assessment of the 60 sites, 30 master trainers were used to cascade train a total of 621 health workers in the diagnosis, management and health education of the major common NCDs identified in a scoping review (hypertension, diabetes, chronic respiratory disease and epilepsy). Pre- and post-training assessments and regular mentoring visits were carried out to assess progress and remedy supply or equipment and medicines shortages and establish reporting systems. The project was accompanied by a series of community engagement activities to raise awareness and improve health seeking behaviour. Results: A total of 643,296 people were screened for hypertension and diabetes leading to a new diagnosis in 24,313 who were started on treatment. Significant numbers of new cases of respiratory disease (3,986) and epilepsy (1,925) were also started on treatment. Mortality rates were low except among patients with hypertension in the rural health centres where 311 (10.2%) died during the project. Loss to follow up (LTFU), defined as failure to attend clinic for > 6 months despite reminders, was low in the hospitals but represented a significant problem in the urban and rural health centres with up to 20 to 30% of patients with hypertension or diabetes absenting from treatment by the end of the project. Estimates of the population disease burden enrolled within the project, however, were disappointing; asthma (0.49%), hypertension (1.7%), epilepsy (3.3%) and diabetes (3.4%). Conclusion: This project demonstrates the feasibility of scaling up integrated NCD services in a variety of locations, with fairly modest costs and a methodology that is replicable and sustainable. However, the relatively small gain in the detection and treatment of common NCDs highlights the huge challenge in making NCD services available to all. Summary points: There is a large body of literature recommending decentralisation of noncommunicable disease (NCD) care, but extremely few "real-world" examples at scale. Those that do are largely examples of NCD care limited to single diseases and in similar geographical or cultural settings. This project provides screening, enrolment and clinical outcomes data for fully integrated, multi-level NCD clinics across a wide geographical area in Africa's second most populous nation. It is one of the first examples of scaled-up comprehensive care for all-comers with chronic noninfectious disease in rural and urban Ethiopia. The extra costs and effort involved in staff training, mentoring and community engagement are not inconsiderable for a modest gain in the detection and treatment of common NCDs. Its major limitation is that it is a "real-world" intervention and observational cohort, studied over a period constrained by a global pandemic and internal civil conflict. It uses routinely collected clinical data, limiting the ability to fully evaluate all relevant clinical outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Improving medication adherence among persons with cardiovascular disease through m-health and community health worker-led interventions in Kerala; protocol for a type II effectiveness-implementation research-(SHRADDHA-ENDIRA).
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Menon, Jaideep C., John, Denny, Sreedevi, Aswathy, Janakiram, Chandrasekhar, R, Akshaya, S, Sumithra, M S, Aravind, Numpeli, Mathews, Gopal, Bipin, B A, Renjini, P K, Sajeev, Lakshmanasamy, Ravivarman, and Kunwar, Abhishek
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PATIENT compliance , *MOBILE health , *CLUSTER randomized controlled trials , *ST elevation myocardial infarction , *CARDIOVASCULAR diseases , *PUBLIC health - Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods: The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion: The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration: The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Implementation and long-term efficacy of a multifaceted intervention to reduce central line-associated bloodstream infections in intensive care units of a low-middle-income country.
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Latif, Asad, Ali, Wajid, Haleem, Sohail, Mahmood, Faisal, Munir, Tahir, Virani, Nazleen, Khan, Hamza, Qadir, Maqbool, Roshan, Rozina, Hooda, Khairunnissa, Khan, Nadeem Mustafa, Zafar, Afia, and Pronovost, Peter
- Abstract
Central line-associated bloodstream infections (CLABSIs) pose a significant risk to critically ill patients, particularly in intensive care units (ICU), and are a significant cause of hospital-acquired infections. We investigated whether implementation of a multifaceted intervention was associated with reduced incidence of CLABSIs. This was a prospective cohort study over nine years. We implemented a bundled intervention approach to prevent CLABSIs, consisting of a comprehensive unit-based safety program (CUSP). The program was implemented in the Neonatal ICU, Medical ICU, and Surgical ICU departments at the Aga Khan University Hospital in Pakistan. The three intervention ICUs combined were associated with an overall 36% reduction in CLABSI rates and a sustained reduction in CLABSI rates for > a year (5 quarters). The Neonatal ICU experienced a decrease of 77% in CLABSI rates lasting ∼1 year (4 quarters). An attendance rate above 88% across all stakeholder groups in each CUSP meeting correlated with a better and more sustained infection reduction. Our multifaceted approach using the CUSP model was associated with reduced CLABSI-associated morbidity and mortality in resource-limited settings. Our findings suggest that a higher attendance rate (>85%) at meetings may be necessary to achieve sustained effects post-intervention. • Successful 36% reduction in CLABSI rates using CUSP in intervention LMIC ICU settings. • Association noted between stakeholder attendance and extent of reduction in CLABSI rates. • Reduction in CLABSI rates sustained for 5 quarters after stopping the CUSP program. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Biomedical engineering point of view on the implementation of rehabilitation technology: a qualitative study.
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García-Añino, Eloísa, Alonso, Juan Pedro, and Catalfamo-Formento, Paola
- Abstract
Purpose: There is a gap between the development of technological innovations for rehabilitation settings and the long-term adoption of the innovations in the settings. The purpose then is to study the developer´s perspectives on barriers and facilitators to the implementation of technological innovations for rehabilitation in clinical settings. Methods: A qualitative research study was undertaken with biomedical engineers working at university. Two focus groups were conducted with open-ended questions to explore their perceptions of technology development and perceived barriers and facilitators during implementation. The analysis included preliminary coding based on the Consolidated Framework for Implementation Research (CFIR), review and discussion of emerging themes. Results: Eleven technology developers (biomedical engineers, researchers) took part in the study. Among the main barriers identified were the fact that the source of the innovations is the literature state of the art, and the underlying aim of the innovations is to provide an original solution. Also the results showed a lack of consensus regarding the end user of the innovations and the lack of consideration of the characteristics valued by the clinic. Among the facilitators identified, the adaptability of the innovations to the clinical setting stands out. Conclusions: In this group of developers there is a duality between the scientific originality of innovations and the transferable nature of these developments. This acts as a barrier to generating technology that meets user requirements. Working in interdisciplinary teams is one of the best alternatives to achieve this. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Designing an implementation science clinical trial to integrate hypertension and cardiovascular diseases care into existing HIV services package in Botswana (InterCARE)
- Author
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Nabila Youssouf, Gaone Edwin Mogaetsho, Thato Moshomo, Tendani Gaolathe, Ponego Ponatshego, Mareko Ramotsababa, Onkabetse Julia Molefe-Baikai, Evelyn Dintwa, Tsaone Kiki, Amelia E. Van Pelt, Karen Steger-May, Laura M. Bogart, Shabbar Jaffar, Pooja Gala, Duolao Wang, Khumo Seipone, Kara Bennett, Kathleen Wirth Hurwitz, Kago Kebotsamang, Lisa R. Hirschhorn, and Mosepele Mosepele
- Subjects
HIV ,Hypertension ,Cardiovascular disease ,Botswana ,Care integration ,Implementation research ,Medicine (General) ,R5-920 - Abstract
Abstract Background Despite success in HIV treatment, diagnosis and management of hypertension (HTN) and cardiovascular disease (CVD) remains suboptimal among people living with HIV (PLWH) in Botswana, with an overall HTN control of only 19% compared to 98% HIV viral suppressed. These gaps persist despite CVD primary care national guidelines and availability of free healthcare including antihypertensive medications. Our study aims to develop and test strategies to close the HTN care gap in PLWH, through integration into HIV care, leveraging the successful national HIV care and treatment program and strategies. Methods The InterCARE trial is a cluster randomized controlled hybrid type 2 effectiveness-implementation trial at 14 sites designed to enroll 4652 adults living with HIV and HTN plus up to 2326 treatment partners. Primary outcomes included effectiveness (HTN control) and implementation outcomes using the Reach Effectiveness Adoption Implementation and Maintenance framework, with explanatory mixed methods used to understand variability in outcomes. InterCARE trial’s main strategies include healthcare worker HTN and CVD care training plus long-term practice facilitation, electronic health record (EHR) documentation of key indicators and use of reminders, and use of treatment partners to provide social support to people living with HIV and HTN. InterCARE started with formative research to identify contextual factors influencing care gaps using the Consolidated Framework for Implementation Research. Results were used to adapt initial and develop additional implementation strategies to address barriers and leverage facilitators. The package was pilot tested in two clinics, with findings used to further adapt or add strategies for the clinical trial. Discussion If successful, the InterCARE model can be scaled up to HIV clinics nationwide to improve diagnosis, management, and support in Botswana. The trial will provide insights for scale-up of HTN integration into HIV care in the region. Trial registration ClinicalTrials.gov reference NCT05414526. Registered 18 May 2022, https://clinicaltrials.gov/study/NCT05414526?term=NCT05414526.&rank=1 .
- Published
- 2024
- Full Text
- View/download PDF
15. Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy
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Yoseph Mamo, Mirchaye Mekoro, David I. W. Phillips, and Andrew Mortimore
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Ethiopia ,Non-communicable disease ,Implementation research ,Comprehensive care ,Decentralisation ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Although primary care models for the care of common non-communicable diseases (NCD) have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. We report the results of a four-year, Ethiopian project to expand this model of NCD care to 15 primary hospitals and 45 health centres encompassing a wide geographical spread and serving a population of approximately 7.5 million people. Methods Following baseline assessment of the 60 sites, 30 master trainers were used to cascade train a total of 621 health workers in the diagnosis, management and health education of the major common NCDs identified in a scoping review (hypertension, diabetes, chronic respiratory disease and epilepsy). Pre- and post-training assessments and regular mentoring visits were carried out to assess progress and remedy supply or equipment and medicines shortages and establish reporting systems. The project was accompanied by a series of community engagement activities to raise awareness and improve health seeking behaviour. Results A total of 643,296 people were screened for hypertension and diabetes leading to a new diagnosis in 24,313 who were started on treatment. Significant numbers of new cases of respiratory disease (3,986) and epilepsy (1,925) were also started on treatment. Mortality rates were low except among patients with hypertension in the rural health centres where 311 (10.2%) died during the project. Loss to follow up (LTFU), defined as failure to attend clinic for > 6 months despite reminders, was low in the hospitals but represented a significant problem in the urban and rural health centres with up to 20 to 30% of patients with hypertension or diabetes absenting from treatment by the end of the project. Estimates of the population disease burden enrolled within the project, however, were disappointing; asthma (0.49%), hypertension (1.7%), epilepsy (3.3%) and diabetes (3.4%). Conclusion This project demonstrates the feasibility of scaling up integrated NCD services in a variety of locations, with fairly modest costs and a methodology that is replicable and sustainable. However, the relatively small gain in the detection and treatment of common NCDs highlights the huge challenge in making NCD services available to all.
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- 2024
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16. Improving hypertension control in Nigeria: early policy implications from the Hypertension Treatment in Nigeria program
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Oluwabunmi Ogungbe, Chibuzor Abasilim, Mark D. Huffman, Dike Ojji, and Hypertension Treatment in Nigeria Program Team
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Hypertension ,Nigeria ,Health Policy ,Delivery of Health Care ,Integrated ,Implementation Research ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Hypertension poses a significant health burden globally. In Nigeria, hypertension prevalence is on the rise, with low rates of awareness, treatment, and control. This policy brief explores the critical gaps addressed by the Hypertension Treatment in Nigeria (HTN) Program, highlighting its strengths, initial outcomes, and scalability in primary care settings. The HTN Program employs an integrated, multilevel care model based on the World Health Organization’s HEARTS technical package, including patient registration and empanelment, team-based care, training and supervision, a standardized treatment protocol, a health information management system, and a drug revolving fund to improve medication accessibility. By December 2023, hypertension treatment and control rates reached surpassing 90% and 50%, respectively, thus underscoring the program’s impact. The HTN Program serves as a model for delivering integrated hypertension care in primary care. Results should be leveraged for political commitment and financing to evaluate and manage non-communicable diseases such as hypertension in primary care through federal and state primary health development agencies. Furthermore, incorporating metrics related to hypertension control and treatment into the Integrated Supportive Management Information System can enhance routine monitoring and evaluation.
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- 2024
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17. No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: evidence from a cluster randomised trial
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James H. Conigrave, K. S. Kylie Lee, Timothy Dobbins, Scott Wilson, José Padarian, Rowena Ivers, Kirsten Morley, Paul S. Haber, Julia Vnuk, Kushani Marshall, and Kate Conigrave
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Implementation research ,Remote support ,Alcohol screening ,AUDIT-C ,Training ,Aboriginal australians ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background While Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs. Methods Design: Cluster randomised trial using routinely collected health data. Setting: Australia. Cases: Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. Measurement: Records of AUDIT-C screening and brief intervention activity in routinely collected data. Results During the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, $$B{F}_{10}$$ $$\approx$$ 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, $$B{F}_{10}$$ $$\approx$$ 0.002) did not improve for the wait-list control group, relative to comparison services. Conclusions We did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources. Trial registration Retrospectively registered on 2018-11-21: ACTRN12618001892202.
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- 2024
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18. Improving medication adherence among persons with cardiovascular disease through m-health and community health worker-led interventions in Kerala; protocol for a type II effectiveness-implementation research-(SHRADDHA-ENDIRA)
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Jaideep C. Menon, Denny John, Aswathy Sreedevi, Chandrasekhar Janakiram, Akshaya R, Sumithra S, Aravind M S, Mathews Numpeli, Bipin Gopal, Renjini B A, Sajeev P K, Ravivarman Lakshmanasamy, and Abhishek Kunwar
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Coronary artery disease ,Factorial study design ,Valvular disease ,Arrhythmia ,Heart failure ,Implementation Research ,Medicine (General) ,R5-920 - Abstract
Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.
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- 2024
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19. Role Development, Implementation and Evaluation of Nurse Practitioners (NUPRA)
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University Ghent
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- 2023
20. Gender-Transformative Interventions for Young Adolescents: What Have We Learned and Where Should We Go?
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Mmari, Kristin, Simon, Callie, and Verma, Ravi
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To identify the key facilitators and barriers to implementing gender-transformative interventions among young adolescents (ages 10–14 years) in low- and middle-income countries and provide recommendations for guiding the next generation of intervention approaches. A scoping review of the literature was first conducted to identify articles that contained the following inclusion criteria: (1) included 10- to 14-year-olds as a target population; (2) addressed gender inequality as a pathway to improved health; (3) implemented in a low- and middle-income country context; and (4) published between 2010 and 2023. Two databases, Scopus and PubMed, were searched as well as the gray literature. Additionally, to collect critical reflections on gender-transformative interventions, two expert meetings and four key informant interviews were conducted. Among the 59 articles which were retrieved and reviewed, 30 were evaluations of specific gender-transformative interventions and the remaining 29 included literature reviews or critical reflections of gender-transformative interventions. Three key themes emerged from our analysis: (1) tailoring approaches for both boys and girls; (2) incorporating multilevel approaches; and (3) engaging multiple sectors, such as health, education, and sports. In each theme, we highlight the primary challenges as well as promising practices for implementation. Efforts should continue unpacking the characteristics of intervention approaches where positive results are found among boys and girls in both implementation and impact. In terms of both multilevel and multisectoral programming, more evidence is needed to help identify which intervention activities should target which populations at what levels and how much to achieve positive impacts among young adolescents. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Past and Present of Implementation Science (Part Ⅱ)——Theories, Paradigm, and Characteristics
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XU Dong, CAI Yiyuan, and CHEN Jiangyun
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implementation science ,implementation research ,theories ,pedals framework ,characteristics ,Medicine - Abstract
Implementation science has evolved over more than 20 years and established a set of theories, models, and frameworks that can be used to guide the implementation process, identify implementation-influencing factors, and evaluate implementation effectiveness. Guided by theories, the implementation research paradigm has been developed to emphasize a problem-oriented approach that seeks to solve problems, identify barriers to implementing evidence-based practices, and selectively employ implementation strategies to facilitate their adoption, implementation, and maintenance. This paradigm also gives implementation research distinctive characteristics in terms of research design, including extensive use of theories, models, and frameworks, alignment with real-world and contextual settings, use of mixed research designs, use of rapid research methods, and optimization of interventions for the context in which they are to be implemented. As the second part of Past and Present of Implementation Science, this paper provides a brief introduction to the theories, paradigms, and characteristics of implementation science.
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- 2024
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22. Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research
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Marjan Mirzania, Elham Shakibazadeh, Meghan A. Bohren, Sedigheh Hantoushzadeh, Abdoljavad Khajavi, and Abbas Rahimi Foroushani
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Maternity care ,Mistreatment ,Multi-level intervention ,Childbirth ,CFIR ,Implementation research ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.
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- 2024
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23. Sexual and reproductive health implementation research in humanitarian contexts: a scoping review
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Alexandra Norton and Hannah Tappis
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Sexual and reproductive health ,Humanitarian settings ,Implementation research ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. Methods A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. Results Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. Conclusion This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Plain English summary Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.
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- 2024
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24. An investigation into the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companionship in Tehran: a qualitative inquiry on mitigating mistreatment of women during childbirth
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Marjan Mirzania, Elham Shakibazadeh, Sedigheh Hantoushzadeh, Zahra Panahi, Meghan A. Bohren, and Abdoljavad Khajavi
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Birth companion ,Implementation research ,Implementation strategies ,Implementation outcomes ,Mistreatment ,Qualitative research ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background A birth companion is a powerful mechanism for preventing mistreatment during childbirth and is a key component of respectful maternity care (RMC). Despite a growing body of evidence supporting the benefits of birth companions in enhancing the quality of care and birth experience, the successful implementation of this practice continues to be a challenge, particularly in developing countries. Our aim was to investigate the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companions to mitigate the mistreatment of women during childbirth in Tehran. Methods This exploratory descriptive qualitative study was conducted between April and August 2023 at Valiasr Hospital in Tehran, Iran. Fifty-two face-to-face in-depth interviews were conducted with a purposive sample of women, birth companions, and maternity healthcare providers. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis, with a deductive approach based on the Implementation Outcomes Framework in the MAXQDA 18. Results Participants found the implemented program to be acceptable and beneficial, however the implementation team noticed that some healthcare providers were initially reluctant to support it and perceived it as an additional burden. However, its adoption has increased over time. Healthcare providers felt that the program was appropriate and feasible, and it improved satisfaction with care and the birth experience. Participants, however, highlighted several issues that need to be addressed. These include the need for training birth companions prior to entering the maternity hospital, informing women about the role of birth companions, assigning a dedicated midwife to provide training, and addressing any physical infrastructure concerns. Conclusion Despite some issues raised by the participants, the acceptability, adoption, appropriateness, feasibility, and fidelity of the implementation strategies for birth companions to mitigate the mistreatment of women during childbirth were well received. Future research should explore the sustainability of this program. The findings of this study can be used to support the implementation of birth companions in countries with comparable circumstances.
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- 2024
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25. Fidelity and acceptability of implementation strategies developed for adherence to a clinical pathway for screening, assessment and management of anxiety and depression in adults with cancer
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Sharon He, Heather Shepherd, Phyllis Butow, Joanne Shaw, Marnie Harris, Mona Faris, Afaf Girgis, The ADAPT Program Group, and Nicole Rankin
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Implementation strategies ,Implementation research ,Cancer ,Clinical pathway ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Implementation strategies are crucial to facilitate implementation success. To prepare and support implementation of a clinical pathway for screening, assessment and management of anxiety and depression in cancer patients (the ADAPT CP), six broad categories of implementation strategies; (1) Awareness campaigns, (2) Champions, (3) Education, (4) Academic Detailing and Support, (5) Reporting, (6) Technological Support, were developed. The aim of this paper is to describe the fidelity and acceptability of six categories of implementation strategies and any subsequent changes/adaptations made to those strategies. Methods The ADAPT CP was implemented in twelve cancer services in NSW, Australia, as part of a cluster randomised controlled trial of core versus enhanced implementation strategies. Fidelity to and any subsequent changes to the delivery of the planned six categories of implementation strategies were captured using the ADAPT contact log, which recorded the contacts made between the ADAPT research team and services, engagement meetings and monthly meetings. To explore acceptability and awareness/engagement with the implementation strategies, interviews with a purposively selected staff sample across both study arms were held prior to implementation (T0), six months into implementation (T1) and at the end of the 12-month implementation period (T2). Interviews were thematically analysed across the six categories of strategies. Results Delivery of all six categories of implementation strategies as planned was moderated by service context and resources and staff engagement. As such, for some implementation strategies, subsequent changes or adaptations to the content, mode of delivery, frequency and duration such as abbreviated training sessions, were made to optimise fidelity to and engagement with the strategies. Most strategies were perceived to be acceptable by service staff. Use of strategies prior to implementation of the ADAPT CP such as the engagement meetings and training sessions, positively impacted on ownership and preparedness to implement the ADAPT CP. Furthermore, ongoing support such as provision of additional training or monthly meetings facilitated increased awareness and engagement with the ADAPT program. Conclusion Flexibility in delivering implementation strategies, and ensuring staff engagement with, and acceptability of those strategies, can support implementation of interventions within healthcare settings. Trial registration The ADAPT CRCT was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true
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- 2024
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26. Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden
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Linn Zettergren, Elin C. Larsson, Lovisa Hellsten, Kyriaki Kosidou, and Anna Maria Nielsen
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Youth clinics ,Implementation research ,Midwives ,Health care providers ,Digital health ,Telehealth ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives’ perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. Methods We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). Results Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives’ preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. Conclusion Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth’ perceptions of digital health care services for sexual and reproductive health.
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- 2024
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27. Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research.
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Mirzania, Marjan, Shakibazadeh, Elham, Bohren, Meghan A., Hantoushzadeh, Sedigheh, Khajavi, Abdoljavad, and Foroushani, Abbas Rahimi
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CHILDBIRTH & psychology , *MATERNAL health services , *HUMAN services programs , *MEDICAL quality control , *QUALITATIVE research , *DELIVERY (Obstetrics) , *RESPECT , *RESEARCH funding , *INTERVIEWING , *CONTENT analysis , *PSYCHOLOGY of women , *JUDGMENT sampling , *ATTITUDES of medical personnel , *RESEARCH , *CONCEPTUAL structures , *PATIENT abuse , *INTEGRATED health care delivery , *WOMEN'S rights - Abstract
Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods: An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions: This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges. Plain English summary: Evidence suggests that mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In this qualitative study, through 30 in-depth interviews with key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals), we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). The data were analyzed using directed content analysis and a deductive approach in MAXQDA 18 software. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability; presence of birth companions: e.g., patient needs and resources); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief childbirth guidelines: e.g., networks and communications). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. [ABSTRACT FROM AUTHOR]
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- 2024
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28. A community health worker led approach to cardiovascular disease prevention in the UK--SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project
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Grice-Jackson, Thomas, Rogers, Imogen, Ford, Elizabeth, Dickinson, Robert, Frere-Smith, Kat, Goddard, Katie, Silver, Linda, Topha, Catherine, Nahar, Papreen, Musinguzi, Geofrey, Bastiaens, Hilde, and Van Marwijk, Harm
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CARDIOVASCULAR disease prevention ,RISK assessment ,HOLISTIC medicine ,PATIENT selection ,MOTIVATIONAL interviewing ,RESEARCH funding ,NATURAL foods ,DATA analysis ,FOCUS groups ,SELF-efficacy ,HUMAN services programs ,QUESTIONNAIRES ,HUMAN research subjects ,STATISTICAL sampling ,INTERVIEWING ,RESPONSIBILITY ,EVALUATION of human services programs ,CARDIOVASCULAR diseases risk factors ,DESCRIPTIVE statistics ,REFLECTION (Philosophy) ,PATIENT-centered care ,THEMATIC analysis ,PRE-tests & post-tests ,INFORMATION needs ,MOTIVATION (Psychology) ,RESEARCH methodology ,CONCEPTUAL structures ,HEALTH behavior ,ACTION research ,FOOD habits ,STATISTICS ,COMMUNITY health workers ,STAKEHOLDER analysis ,INDIVIDUALIZED medicine ,MEDICAL screening ,DATA analysis software ,PSYCHOSOCIAL factors ,PREVENTIVE health services ,PATIENT participation ,DIET ,PHYSICAL activity - Abstract
Background: This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support underserved populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. Methods: A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Results: Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Conclusion: Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Barriers and facilitators to implementing evidence-based integrated HIV and behavioral health care: perspectives from seven federal ending the HIV epidemic jurisdictions.
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McKinnon, Karen, Lentz, Cody, Boccher-Lattimore, Daria, Cournos, Francine, Pather, Ariana, Sukumaran, Stephen, Thompson, Adam, DeLorenzo, Lori, Hager, Michael, Remien, Robert H., and Mellins, Claude A.
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The federal Ending the HIV Epidemic (EHE) initiative was created to reduce new US HIV infections, largely through pre-exposure prophylaxis and HIV treatments that reduce HIV transmissibility to zero. Behavioral health disorders (mental health and substance use) remain significant barriers to achieving EHE goals. Addressing behavioral health (BH) disorders within HIV primary care settings has been promoted as a critical EHE strategy. Implementation of efficacious HIV-BH care integration and its impact on HIV-related health outcomes is not well documented. In a federally-funded, exploratory phase implementation science study, we used the Collective Impact Framework to engage partners in seven EHE jurisdictions about the feasibility, acceptability, and sustainability of implementing HIV-BH integration interventions within local HIV settings. Partners concluded that full integration will remain the exception unless health systems invest in collaborative practice, professional training, appropriate health technology, and inter-system communication. Partners supported smaller incremental improvements including transdiagnostic approaches to reinforce each team member’s sense of value in the shared endeavor. This early phase implementation science study identified research and implementation gaps that are critical to fill to end the HIV epidemic. Both the Collective Impact Framework and implementation science show promise for guiding future implementation of evidence-based HIV-BH intervention integration. [ABSTRACT FROM AUTHOR]
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- 2024
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30. Practitioners support and intention to adopt universal access to self‐collection in Australia's National Cervical Screening Program.
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Creagh, Nicola Stephanie, Saunders, Tessa, Brotherton, Julia, Hocking, Jane, Karahalios, Amalia, Saville, Marion, Smith, Megan, and Nightingale, Claire
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DIFFUSION of innovations theory , *AUSTRALIANS , *GENERAL practitioners , *CERVICAL cancer , *INTENTION - Abstract
Objective: Primary care practitioners are crucial to engaging people in Australia's national cervical screening program. From July 2022, practitioners have been able to offer all screen‐eligible people the choice to collect their own self‐collected sample; an option introduced to increase equity. This study explored how practitioners are intending to incorporate universal access to self‐collection into their clinical care. Methods: Semi‐structed interviews with 27 general practitioners, nurses, and practice managers from 10 practices in Victoria, Australia conducted between May and August 2022. Interviews were deductively coded, informed by the Consolidated Framework for Implementation Research. The Diffusion of Innovations theory was used to categorise intention to provide self‐collection. Results: Participants were supportive of universal access to self‐collection, citing benefits for screen‐eligible people and that it overcame the limited adaptability of the previous policy. Most participants' practices (n = 7, 70%) had implemented or had plans to offer the option for self‐collection to all. Participants deliberating whether to provide universal access to self‐collection held concerns about the correct performance of the self‐test and the perceived loss of opportunity to perform a pelvic examination. Limited time to change practice‐level processes and competing demands within consultations were anticipated as implementation barriers. Conclusions: The extent to which self‐collection can promote equity within the program will be limited without wide‐spread adoption by practitioners. Communication and education that addresses concerns of practitioners, along with targeted implementation support, will be critical to ensuring that self‐collection can increase participation and Australia's progression towards elimination of cervical cancer. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.
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Norton, Alexandra and Tappis, Hannah
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MEDICAL information storage & retrieval systems , *REPRODUCTIVE health , *WOMEN , *CINAHL database , *SYSTEMATIC reviews , *MEDLINE , *MEDICAL research , *LITERATURE reviews , *CONCEPTUAL structures , *HEALTH promotion , *ONLINE information services , *EVIDENCE-based medicine , *MEDICAL needs assessment , *SEXUAL health , *PSYCHOLOGY information storage & retrieval systems , *HEALTH care rationing - Abstract
Background: Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. Methods: A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. Results: Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. Conclusion: This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Plain English summary: Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. [ABSTRACT FROM AUTHOR]
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- 2024
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32. An investigation into the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companionship in Tehran: a qualitative inquiry on mitigating mistreatment of women during childbirth.
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Mirzania, Marjan, Shakibazadeh, Elham, Hantoushzadeh, Sedigheh, Panahi, Zahra, Bohren, Meghan A., and Khajavi, Abdoljavad
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CHILDBIRTH , *MEDICAL personnel , *MATERNAL health services , *CHILDBIRTH at home , *WOMEN'S hospitals , *SATISFACTION , *JUDGMENT sampling - Abstract
Background: A birth companion is a powerful mechanism for preventing mistreatment during childbirth and is a key component of respectful maternity care (RMC). Despite a growing body of evidence supporting the benefits of birth companions in enhancing the quality of care and birth experience, the successful implementation of this practice continues to be a challenge, particularly in developing countries. Our aim was to investigate the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companions to mitigate the mistreatment of women during childbirth in Tehran. Methods: This exploratory descriptive qualitative study was conducted between April and August 2023 at Valiasr Hospital in Tehran, Iran. Fifty-two face-to-face in-depth interviews were conducted with a purposive sample of women, birth companions, and maternity healthcare providers. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis, with a deductive approach based on the Implementation Outcomes Framework in the MAXQDA 18. Results: Participants found the implemented program to be acceptable and beneficial, however the implementation team noticed that some healthcare providers were initially reluctant to support it and perceived it as an additional burden. However, its adoption has increased over time. Healthcare providers felt that the program was appropriate and feasible, and it improved satisfaction with care and the birth experience. Participants, however, highlighted several issues that need to be addressed. These include the need for training birth companions prior to entering the maternity hospital, informing women about the role of birth companions, assigning a dedicated midwife to provide training, and addressing any physical infrastructure concerns. Conclusion: Despite some issues raised by the participants, the acceptability, adoption, appropriateness, feasibility, and fidelity of the implementation strategies for birth companions to mitigate the mistreatment of women during childbirth were well received. Future research should explore the sustainability of this program. The findings of this study can be used to support the implementation of birth companions in countries with comparable circumstances. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Fidelity and acceptability of implementation strategies developed for adherence to a clinical pathway for screening, assessment and management of anxiety and depression in adults with cancer.
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He, Sharon, Shepherd, Heather, Butow, Phyllis, Shaw, Joanne, Harris, Marnie, Faris, Mona, Girgis, Afaf, Beale, Philip, Clayton, Josephine, Cuddy, Jessica, Davies, Fiona, Dhillon, Haryana, Geerligs, Liesbeth, Grimison, Peter, Hack, Thomas, Kelly, Brian, Kelly, Patrick, Kirsten, Laura, Lindsay, Toni, and Lovell, Melanie
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CANCER patients ,MEDICAL screening ,ANXIETY ,MENTAL depression - Abstract
Background: Implementation strategies are crucial to facilitate implementation success. To prepare and support implementation of a clinical pathway for screening, assessment and management of anxiety and depression in cancer patients (the ADAPT CP), six broad categories of implementation strategies; (1) Awareness campaigns, (2) Champions, (3) Education, (4) Academic Detailing and Support, (5) Reporting, (6) Technological Support, were developed. The aim of this paper is to describe the fidelity and acceptability of six categories of implementation strategies and any subsequent changes/adaptations made to those strategies. Methods: The ADAPT CP was implemented in twelve cancer services in NSW, Australia, as part of a cluster randomised controlled trial of core versus enhanced implementation strategies. Fidelity to and any subsequent changes to the delivery of the planned six categories of implementation strategies were captured using the ADAPT contact log, which recorded the contacts made between the ADAPT research team and services, engagement meetings and monthly meetings. To explore acceptability and awareness/engagement with the implementation strategies, interviews with a purposively selected staff sample across both study arms were held prior to implementation (T0), six months into implementation (T1) and at the end of the 12-month implementation period (T2). Interviews were thematically analysed across the six categories of strategies. Results: Delivery of all six categories of implementation strategies as planned was moderated by service context and resources and staff engagement. As such, for some implementation strategies, subsequent changes or adaptations to the content, mode of delivery, frequency and duration such as abbreviated training sessions, were made to optimise fidelity to and engagement with the strategies. Most strategies were perceived to be acceptable by service staff. Use of strategies prior to implementation of the ADAPT CP such as the engagement meetings and training sessions, positively impacted on ownership and preparedness to implement the ADAPT CP. Furthermore, ongoing support such as provision of additional training or monthly meetings facilitated increased awareness and engagement with the ADAPT program. Conclusion: Flexibility in delivering implementation strategies, and ensuring staff engagement with, and acceptability of those strategies, can support implementation of interventions within healthcare settings. Trial registration: The ADAPT CRCT was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true [ABSTRACT FROM AUTHOR]
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- 2024
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34. Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation.
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Cappon, Leen, Heyndrickx, Manon, Rowaert, Sara, Grootaert, Nathalie, de Decker, An, Tremmery, Sabine, Vandevelde, Stijn, and De Varé, Jan
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RECORDING & registration , *QUALITATIVE research , *FOCUS groups , *FORENSIC psychiatry - Abstract
Available research emphasizes the importance of getting a systematic overview of inpatient aggression in forensic psychiatric care. However, the same research does not focus on how systematic aggression registration should be introduced in clinical practice. To facilitate the use of systematic aggression registration instruments, it is very relevant to gain insight into the perspective of staff members on the introduction of these instruments in daily clinical practice. Additionally, preconditions for achieving a successful implementation can be considered. Therefore, this study aims to gain insight into the perspective of the staff members on the implementation of a systematic aggression registration instrument—that is, the MOAS—in a forensic psychiatric unit. Interviews (n = 8) and a focus group with staff members were carried out. Three main themes: (1) creating the most appropriate context for introduction, (2) choice for the MOAS as relevant instrument, and (3) perpetuating the use of the MOAS in clinical practice are scrutinized. The mentioned preconditions can be used as guidelines when implementing systematic aggression registration in clinical practice. We hope that this paper can inspire other forensic psychiatric facilities to introduce systematic registration of aggressive incidents. [ABSTRACT FROM AUTHOR]
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- 2024
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35. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed‐method pre‐implementation study using the Consolidated Framework for Implementation Research
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Yimsaard, Pongkwan, Mootz, Jennifer J., Rungnirundorn, Teerayuth, Janamnuaysook, Rena, Samitpol, Kritima, Phanuphak, Nittaya, and Wainberg, Milton L.
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HEALTH services accessibility , *POLICY sciences , *QUALITATIVE research , *RESEARCH funding , *RESEARCH methodology evaluation , *INTERVIEWING , *CRISIS intervention (Mental health services) , *QUANTITATIVE research , *DESCRIPTIVE statistics , *ALCOHOL-induced disorders , *LONGITUDINAL method , *THEMATIC analysis , *RESEARCH methodology , *STATISTICS , *MEDICAL screening , *TRANS women , *PSYCHOLOGICAL tests , *HEALTH equity , *ALCOHOL drinking , *COMPARATIVE studies , *MEDICAL referrals - Abstract
Background and aims: Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. Design: A mixed‐method approach was used. In the first phase, TGW service users and health‐care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test‐Consumption (AUDIT‐C). In the second phase, TGW service users, HCPs, clinic administrators and national‐level alcohol, HIV and transgender health policymakers participated in in‐depth qualitative interviews. Setting: The Tangerine Clinic, a transgender‐led sexual health clinic in Bangkok, Thailand. Participants: In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. Measurements Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. Findings Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT‐C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. Conclusion: Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender‐led sexual health clinic settings, with some adaptations to overcome anticipated barriers. [ABSTRACT FROM AUTHOR]
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- 2024
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36. Particularity, Engagement, Actionable Inferences, Reflexivity, and Legitimation tool for rigor in mixed methods implementation research.
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Younas, Ahtisham and Fàbregues, Sergi
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Background Purpose Data Sources Conclusion Clinical Relevance Implementation science helps generate approaches to expedite the uptake of evidence in practice. Mixed methods are commonly used in implementation research because they allow researchers to integrate distinct qualitative and quantitative methods and data sets to unravel the implementation process and context and design contextual tools for optimizing the implementation. To date, there has been limited discussion on how to ensure rigor in mixed methods implementation research.To present Particularity, Engagement, Actionable Inferences, Reflexivity, and Legitimation (PEARL) as a practical tool for understanding various components of rigor in mixed methods implementation research.This methodological discussion is based on a nurse‐led mixed methods implementation study. The PEARL tool was developed based on an interpretive, critical reflection, and purposive reading of selected literature sources drawn from the researchers' knowledge, experiences of designing and conducting mixed methods implementation research, and published methodological papers about mixed methods, implementation science, and research rigor.An exemplar exploratory sequential mixed methods study in nursing is provided to illustrate the application of the PEARL tool. The proposed tool can be a useful and innovative tool for researchers and students intending to use mixed methods in implementation research. The tool offers a straightforward approach to learning the key rigor components of mixed methods implementation research for application in designing and conducting implementation research using mixed methods.Rigorous implementation research is critical for effective uptake of innovations and evidence‐based knowledge into practice and policymaking. The proposed tool can be used as the means to establish rigor in mixed methods implementation research in nursing and health sciences. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Development of an implementation science informed "Test Evidence Transition" program to improve cancer outcomes.
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Hamilton-West, Kate E., Feast, Alexandra, Masento, Natalie A., Knowles, Brian, Sloan, Claire, and Weaver, Luke
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HUMAN services programs ,DIFFUSION of innovations ,RESEARCH funding ,LEADERSHIP ,EVALUATION of medical care ,TRANSLATIONAL research ,MOTIVATION (Psychology) ,MEDICAL research ,CONCEPTUAL structures ,ENDOWMENT of research ,EMPLOYEE recruitment ,TUMORS ,EVIDENCE-based medicine ,HEALTH care teams - Abstract
Introduction: Translation of cancer research into practice takes around 15 years. Programs informed by implementation science methods and frameworks offer potential to improve cancer outcomes by addressing the implementation gap. Methods: We describe the development of a Test Evidence Transition (TET) program which provides funding and support to health system delivery teams and project design and evaluation partners working together to achieve three objectives: Test innovations to support optimal cancer pathways that transform clinical practice; Evidence the process, outcome, and impact of implementation; and work with strategic partners to ensure the Transition of best practice into effective and equitable adoption across UK health systems. Results: Phase 1 launched in April 2023. Teams with the capability and motivation to implement evidence-based pathway innovations were identified and invited to submit expressions of interest. Following peer-review, teams were supported to develop full proposals with input from academics specializing in health services research, evaluation, and implementation science. Projects were selected for funding, providing an opportunity to implement and evaluate innovations with support from academic and health system partners. Conclusions: TET aims to improve cancer outcomes by identifying and addressing local-level barriers to evidence-based practice and translating findings into consistent and equitable adoption across health systems. Phase 1 projects focus on pathway innovations in diagnosis for breast and prostate cancer. We are now launching Phase 2, focusing on colorectal cancer. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden.
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Zettergren, Linn, Larsson, Elin C., Hellsten, Lovisa, Kosidou, Kyriaki, and Nielsen, Anna Maria
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REPRODUCTIVE health services , *MEDICAL care , *MEDICAL quality control , *YOUTH services , *MEDICAL personnel , *DIGITAL health - Abstract
Background: Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. Methods: We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). Results: Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. Conclusion: Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Innovating new frontiers in service delivery and evidence generation.
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Chowdhury, Ahmed Mushtaque Raza
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NONGOVERNMENTAL organizations , *PUBLIC sector , *HEALTH programs - Abstract
Over the past half a century since its independence, Bangladesh has done exceptionally well in human development, including the health sector. In addition to the public sector, the many innovative interventions implemented at scale by non-governmental organisations (NGOs) made important contributions in this story. This paper narrates the story of BRAC, one of the largest NGOs, highlighting a few of its selected health intervention programmes. It also describes how an internal research outfit played a significant role in BRAC's success. [ABSTRACT FROM AUTHOR]
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- 2024
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40. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science.
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Adsul, Prajakta, Shelton, Rachel C., Oh, April, Moise, Nathalie, Iwelunmor, Juliet, and Griffith, Derek M.
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HEALTH equity , *WORLD health , *RESOURCE-limited settings , *INSTITUTIONAL racism , *POPULATION health - Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity. [ABSTRACT FROM AUTHOR]
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- 2024
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41. Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care.
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Husum, Tonje Lossius, Wormdahl, Irene, Kjus, Solveig H. H., Hatling, Trond, and Rugkåsa, Jorun
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EVALUATION of human services programs ,MENTAL health services ,CONTROL (Psychology) ,PATIENTS ,QUALITATIVE research ,SECONDARY analysis ,HEALTH facility administration ,INTERPROFESSIONAL relations ,RESEARCH funding ,PRIMARY health care ,HOSPITAL admission & discharge ,INTERVIEWING ,LEADERSHIP ,EVALUATION of medical care ,THEMATIC analysis ,ORGANIZATIONAL effectiveness ,INSTITUTIONAL cooperation ,ATTITUDES of medical personnel ,STAKEHOLDER analysis ,ACCESS to information ,PROFESSIONAL competence - Abstract
Background: Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the 'Reducing Coercion in Norway' (ReCoN) intervention that aims to reduce involuntary admissions by improving the way in which primary mental health services work and collaborate. The intervention was implemented in five municipalities and is being tested in a cluster randomized control trial, which is yet to be published. The present study evaluates the implementation process in the five intervention municipalities. To assess how the intervention was executed, we report on how its different elements were implemented, and what helped or hindered implementation. Methods: We assessed the process using qualitative methods. Data included detailed notes from quarterly progress interviews with (i) intervention coordinators and representatives from (ii) user organisations and (iii) carer organisations. Finally, an end-of-intervention evaluation seminar included participants from across the sites. Results: The majority of intervention actions were implemented. We believe this was enabled by the co-creating process, which ensured ownership and a good fit for the local setting. The analysis of facilitators and barriers showed a high degree of interconnectedness between different parts of the intervention so that success (or lack thereof) in one area affected the success in others. Future implementation should pay attention to enhanced planning and training, clarify the role and contribution of service user and carer involvement, and pay close attention to the need for implementation support and whether this should be external or internal to services. Conclusions: It is feasible to implement a complex intervention designed to reduce the use of involuntary admissions in general support services, such as the Norwegian primary mental health services. This could have implications for national and international policy aimed at reducing the use of involuntary care. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Using Implementation Research to Inform Scaling of Parenting Programs: Independently Conducted Case Studies from Zambia and Bhutan.
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Aboud, Frances, Choden, Karma, Hapunda, Given, Sichimba, Francis, Chaluda, Ania, Contreras Gomez, Rafael, Hatch, Rachel, Dang, Sara, Dyenka, Karma, Banda, Cecilia, and Omoeva, Carina
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EVALUATION of human services programs ,MEDICAL quality control ,RESEARCH funding ,PARENTING education ,PARTICIPANT observation ,MEDICAL care ,QUESTIONNAIRES ,INTERVIEWING ,STATISTICAL sampling ,JUDGMENT sampling ,ATTITUDES of medical personnel ,RESEARCH methodology ,QUALITY assurance ,LABOR supply ,EMPLOYEES' workload - Abstract
Two case studies of parenting programs for parents of children 0 to 36 months of age, developed and implemented by Save the Children/Ministry of Health/Khesar Gyalpo University in Bhutan and UNICEF Zambia, were conducted by an independent research group. The focus was on how program delivery and scale-up were revised on the basis of feedback from implementation research. Feedback on workforce delivery quality was based on observations of deliveries using a monitoring form, as well as survey and interview data collected from the workforce. In-depth interviews with the resource team during the fourth year of implementation revealed how the feedback was used to address horizontal and vertical scaling. Delivery quality was improved in some cases by revising the delivery manual, offering refresher courses, and instituting regular monitoring. Scaling challenges in Zambia included slow progress with regard to reaching families in the two districts, which they addressed by trialing group sessions, and stemming workforce attrition. The challenges in Bhutan were low attendance and reducing the workload of providers. Vertical scaling challenges for both countries concerned maintaining demand through continuous advocacy at community and government levels to sustain financing and to show effectiveness in outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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43. Evaluating the implementation of a hypertension program based on mHealth and community pharmacies integration to primary care centers at a municipality level in Argentina during the COVID-19 pandemic
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M. E. Esandi, Z. Ortiz, V. Bernabei, N. B. Villalba, S. Liggio, M. Della Maggiora, N. A. García, A. Bruzzone, G. Blanco, D. Prieto Merino, H. Legido Quigley, and P. Perel
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hypertension ,primary care ,community pharmacies ,mHealth ,implementation research ,low- and middle-income countries ,Medicine - Abstract
IntroductionWhile pharmacists-led interventions in hypertension have proven effective in high-income countries, their implementation and impact in low- and middle-income countries (LMIC) remain limited. This study assessed the implementation and outcomes of the hypertension program FarmaTeCuida (FTC), which integrated community pharmacies into the public primary care level using information and communication technologies. The study took place during the pandemic in General Pueyrredón, Buenos Aires, Argentina, so modifications to the implementation strategy and expected outcomes were also analyzed.MethodsA mixed-methods study was conducted using the non-adoption, abandonment, scaling-up, dissemination, and sustainability (NASSS) conceptual model. Qualitative in-depth interviews were conducted with key stakeholders using snowball sampling until thematic saturation was achieved. The quantitative approach employed a quasi-experimental, prospective, longitudinal design in a cohort of hypertensive patients enrolled in the FTC program since October 2020 to March 2022. Adoption, access, adherence to follow-up, and blood pressure levels were assessed. Clinical outcomes were compared to a cohort of hypertensive patients attending primary health care centers (PHCCs) in 2021 but not enrolled in the FTC program. Routine data from this cohort was obtained from the municipal health information system (HIS).ResultsOut of 33 PHCCs, 23 adopted the FTC program, but only four collaborated with community pharmacies. A total of 440 patients were recruited, with 399 (91%) enrolled at PHCCs. Hypertension was detected in 63% (279/440) of cases at the first visit (113 were possible hypertensive patients; 26 new hypertensive patients and 140 already diagnosed). During follow-up, FTC identified 52 new hypertensive patients (12% out of 440). Reduction of systolic blood pressure (SBP) was observed in patients enrolled in both the FTC program and the comparison group over 60 days. In the multivariate analysis that included all hypertensive patient (FTC and HIS) we found strong evidence that for each month of follow up, SBP was reduced by 1.12 mmHg; however, we did not find any significant effect of the FTC program on SBP trend (interaction FTC*months has a p-value = 0.23). The pandemic was identified as the main reason for the program's underperformance; in addition we identified barriers related to technology, patient suitability, implementation team characteristics, and organizational factors.DiscussionOur study, grounded in the NASSS model, highlights the profound complexity of introducing innovative strategies in low- and middle-income settings. Despite substantial challenges posed by the pandemic, these obstacles provided valuable insights, identified areas for improvement, and informed strategies essential for reshaping the care paradigm for conditions like hypertension in resource-constrained environments.
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- 2024
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44. Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review
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Abigail H. Neel, Adetoun Olateju, Michael A. Peters, Meike Schleiff, and Olakunle Alonge
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implementation research ,implementation strategies ,implementation outcomes ,polio ,global polio eradication initiative ,Medicine - Abstract
IntroductionThere is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings.MethodsWe nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact).Results152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated.ConclusionsThis review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs.
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- 2024
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45. Editorial: Global excellence in implementation science: Europe
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Ana Gama, Tayana Soukup, and Sónia Dias
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health interventions ,implementation science ,complex interventions ,evaluation research ,implementation research ,Medicine - Published
- 2024
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46. Editorial: Global excellence in implementation science: Europe.
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Gama, Ana, Soukup, Tayana, and Dias, Sónia
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SERIAL publications ,HEALTH services accessibility ,MEDICAL quality control ,PUBLIC health ,HEALTH promotion ,NEEDS assessment - Published
- 2024
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47. Deaf Weight Wise: Community-engaged Implementation Research to Promote Healthy Lifestyle Change With Deaf American Sign Language Users
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Steve Barnett, Principal Investigator
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- 2023
48. Development and validation of a national clinical pharmacy competency framework for hospital pharmacists in Austria: a multi-method study
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Stoll, J. T., Böhmdorfer-McNair, B., Jeske, M., and Weidmann, A. E.
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- 2024
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49. Preparing Children for Invasive Medical Cancer Treatment with “My Logbook”: Preliminary Results of a Pilot Study
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Weiler-Wichtl, Liesa J., Fohn-Erhold, Verena, Rosenmayr, Verena, Hansl, Rita, Hopfgartner, Maximilian, Fries, Jonathan, Schneider, Carina, Herzog, Kristina, Schellenberg, Tobias, Schönthaler, Barbara, Stember, Nicole, Lein-Köhler, Iris, Hoffmann, Rahel, Kollmann, Alina, Salzmann, Nicole, Essl, Stefanie, Pal-Handl, Katharina, Wasinger-Brandweiner, Verena, Rinner, Sarah, Schubert, Lisa, Lange, Sandra, and Leiss, Ulrike
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- 2024
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50. Past and Present of Implementation Science (PartⅠ)—Origin and Development
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XU Dong, CHEN Jiangyun, and CAI Yiyuan
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implementation science ,implementation research ,origin ,development ,opportunities and challenges ,Medicine - Abstract
Implementation science aims to close the gap between knowledge and practice by fostering the uptake and implementation of evidence-based practices. In Europe and America, implementation science is rapidly evolving and improving. In China, the field is still in its infancy. This paper focuses on the definition, origin, domestic and international development, research hotspots, challenges, and opportunities of implementation science. Although implementation science is still at an early stage in China, it has shown rapid development momentum. Chinese scholars, therefore, should leverage China's distinctive research environment to conduct high-quality and innovation implementation studies in order to excel in implementation science areas and lead globally.
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- 2024
- Full Text
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