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Background: Despite evidence supporting interventions that improve outcomes for patients with stroke, their implementation remains suboptimal. Facilitation can support implementation of research into clinical practice by helping people develop the strategies to implement change. However, variability in the amount (dose) and type of facilitation activities/facilitator roles that make up the facilitation strategies (content), may affect the effectiveness of facilitation. This review aimed to determine if, and how, facilitation dose is measured or reported and the type of facilitation strategies used to support adoption of stroke interventions in hospitals and subacute settings. We also assessed whether the included studies had reporting checklists or guidelines. Methods: The scoping review was based on Arksey and O'Malley's framework. Cochrane, CINAHL and MEDLINE databases were searched to identify randomised trials and quasi-experimental studies of stroke interventions published between January 2017 and July 2023. Accompanying publications (quantitative, qualitative, mixed methods or process evaluation papers) from eligible studies were also included. Narrative data synthesis was undertaken. Results: Ten studies (23 papers) from 649 full-text papers met the inclusion criteria. Only two studies reported the total facilitation dose, measured as the frequency and duration of facilitation encounters. Authors of the remaining eight studies reported only the frequency and/or duration of varying facilitation activities but not the total dose. The facilitation activities included remote external facilitator support via ongoing telecommunication (phone calls, emails, teleconferences), continuous engagement from on-site internal facilitators, face-to-face workshops and/or education sessions from external or internal facilitators. Facilitator roles were broad: site-specific briefing, action planning and/or goal setting; identifying enablers and barriers to change; coaching, training, education or feedback; and network support. Only two studies included reporting checklists/guidelines to support researchers to describe interventions and implementation studies in sufficient detail to enable replication. Conclusions: There is a paucity of information on the measurement of facilitation dose and reporting on specific details of facilitation activities in stroke implementation studies. Detailed reporting of dose and content is needed to improve the scientific basis of facilitation as strategic support to enable improvements to stroke care. Development of a standardised measurement approach for facilitation dose would inform future research and translation of findings. [ABSTRACT FROM AUTHOR]

Background: Implementation strategies are essential to deliver evidence-based programs that align with local context, resources, priorities, and preferences. However, it is not always clear how specific strategies are selected (vs. others) and strategies are not always operationalized clearly, distinctly, and dynamically. Implementation logic models provide one useful way to conceptualize the role and selection of implementation strategies, plan evaluation of their intended impacts on implementation and effectiveness outcomes, and to communicate key aspects of a project. Methods: This paper describes our initial plans, experiences, and lessons learned from applying implementation logic models in the Quadruple Aim Quality Enhancement Research Initiative (QUERI) a large multi-study program funded by the Veterans Health Administration (VA). We began with two primary implementation strategies based on our earlier work (i.e., Iterative RE-AIM and Relational Facilitation) that were applied across three different health outcomes studies. Results: Our implementation strategies evolved over time, and new strategies were added. This evolution and reasons for changes are summarized and illustrated with the resulting logic models, both for the overall Quadruple Aim QUERI and the three specific projects. We found that implementation strategies are often not discrete, and their delivery and adaptation is dynamic and should be guided by emerging data and evolving context. Review of logic models across projects was an efficient and useful approach for understanding similarities and differences across projects. Conclusions: Implementation logic models are helpful for clarifying key objectives and issues for both study teams and implementation partners. There are challenges in logic model construction and presentation when multiple strategies are employed, and when strategies change over time. We recommend presentation of both original and periodically updated project models and provide recommendations for future use of implementation logic models. [ABSTRACT FROM AUTHOR]

Background and Aims Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing. Methods At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE). Results In total, 2008 patients (46% male, median age 63 years) were randomized from October 2019 to September 2022. When randomized to CAD-score (n = 1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤ 5%, and 39.5% had CAD-score ≤ 20. Testing was deferred in 22% with no differences in diagnostic tests between groups (P for superiority =.56). In the PTP ≤ 5% subgroup, the proportion with deferred testing increased from 28% to 52% (P <.001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.49% (95% confidence interval −1.96–0.97) (P for non-inferiority =.003). No differences were seen in angina-related health status or quality of life. Conclusions The implementation strategy of providing cardiologists with a CAD-score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated that standardizing labor induction (IOL), often with the use of protocols, may reduce racial inequities in obstetrics. IOL protocols are complex, multi-component interventions. To target identified implementation barriers, audit and feedback (A&F) was selected as an implementation strategy. Here, we aimed to understand the acceptability and effect of A&F on fidelity to this complex intervention through quantitative and qualitative approaches. Methods: This secondary analysis of a type I hybrid effectiveness-implementation trial (10/2018–12/2022) compared 2 years before (PRE) to 2 years after (POST) implementation of an IOL protocol at two sites. Fidelity to each of 8 specific protocol components was collected via chart review. During the POST period, unit-aggregated A&F reports were distributed via email every 3 months to site clinicians. Reports tracked fidelity to protocol components over time. For this analysis, we compared component fidelity PRE to POST-implementation. Additionally, during the POST period, we compared fidelity by month after each A&F (Month#1 v. Month#2/3) to evaluate the effect of A&F over time. Acceptability of A&F reports was evaluated using qualitative interviews. Results: 8509 labor inductions were included (PRE = 4214, POST = 4295). A&F reports were successfully distributed every 3 months for the 2-year POST period. PRE to POST-implementation, fidelity to 4 of the 8 components increased significantly (cervical Foley utilization, latent labor examination frequency, amniotomy timing, and intrauterine pressure catheter utilization), without change in the other 4 components. For 2 of those 4 components where improvement was noted, there was no difference in fidelity by month after A&F report; rather, there was sustained improvement across the POST-implementation period. On the other hand, for the remaining 2 components, fidelity peaked in the first month after each A&F report, with some decline in the following 2 months prior to the next A&F report. Qualitative analysis (n = 24) supported A&F acceptability, with A&F described as "motivating" and "helpful." Conclusions: A&F was an effective implementation strategy to promote fidelity to certain components of this labor induction protocol. With some decline in effect after the first month POST-A&F report, increased A&F frequency should be considered in future work targeting obstetric outcomes, as well as health inequities. [ABSTRACT FROM AUTHOR]

Background: Health care professionals often fail to adhere to evidence-based guidelines. The implementation of evidence-based methods in health care requires systematic support, but it is still unclear which strategies support professional adherence to clinical practice guidelines. Behavior change techniques can contribute to a more detailed description of implementation strategies. The aim of this scoping review was to explore the nature of studies investigating the sustainability of physiotherapists' (PTs') and occupational therapists' (OTs') clinical behavior when implementing evidence-based methods in health care. Two research questions were addressed: (1) Which implementation strategies are used in studies that have experienced sustained and unsustained changes in the clinical behavior of PTs and OTs? (2) Which behavior change techniques are used in studies involving sustained and unsustained changes in the clinical behavior of PTs and OTs? Methods: The scoping review was carried out in accordance with recommendations and the PRISMA-ScR checklist. Six databases were searched. Studies evaluating changes in the clinical behavior of PTs or OTs before and at least 6 months after the end of an implementation intervention were included. Results: A total of 5130 studies were screened, and 29 studies were included. Twenty-one studies reported sustained results, and 8 studies reported unsustained results. The studies reporting sustained clinical behavior used in median 7 implementation strategies, 45% used a 12–24-month implementation support period, and 86% of the interventions were theory-based. Twenty-two implementation strategies were identified among the included studies. Only two of these defined the implementation strategies in terms of behavior change techniques. Conclusions: Studies reporting sustained results were characterized by the use of longer implementation periods, more implementation strategies, more theory-based interventions, and more behavior change techniques. Audit and feedback, resources, problem solving, and communities of practice were implementation strategies, and problem solving, demonstration of behavior, and social support were behavior change techniques that were more common in studies with sustained results of PTs' and OTs' clinical behavior. Our study also highlights the importance of well-described implementation studies. Registration: The protocol for the scoping review has been registered in the Open Science Framework, OSF registry (https://doi.org/10.17605/OSF.IO/DUYQM). [ABSTRACT FROM AUTHOR]

Background: In healthcare research and practice, intervention and implementation fidelity represent the steadfast adherence to core components of research-supported interventions and the strategies employed for their implementation. Evaluating fidelity involves determining whether these core components were delivered as intended. Without fidelity data, the results of complex interventions cannot be meaningfully interpreted. Increasingly, the necessity for firmness and strict adherence by implementers and their organizations has been questioned, with calls for flexibility to accommodate contextual conditions. This shift makes contemporary fidelity a balancing act, requiring researchers to navigate various tensions. This debate paper explores these tensions, drawing on experiences from developing fidelity assessments in two ongoing effectiveness-implementation hybrid trials. Main body: First, given often scarce knowledge about the core components of complex interventions and implementation strategies, decisions about fidelity requirements involve a degree of subjective reasoning. Researchers should make these decisions transparent using theory or logic models. Second, because fidelity is context-dependent and applies to both interventions and implementation strategies, researchers must rethink fidelity concepts with every study while balancing firmness and flexibility. This is particularly crucial for hybrid studies, with their differing emphasis on intervention and implementation fidelity. Third, fidelity concepts typically focus on individual behaviors. However, since organizational and system factors also influence fidelity, there is a growing need to define fidelity criteria at these levels. Finally, as contemporary fidelity concepts prioritize flexible over firm adherence, building, evaluating, and maintaining fidelity in healthcare research has become more complex. This complexity calls for intensified efforts to expand the knowledge base for pragmatic and adaptive fidelity measurement in trial and routine healthcare settings. Conclusion: Contemporary conceptualizations of fidelity place greater demands on how fidelity is examined, necessitating the expansion of fidelity frameworks to include organizational and system levels, the service- and study-specific conceptualizations of intervention and implementation fidelity, and the development of pragmatic approaches for assessing fidelity in research and practice. Continuing to build knowledge on how to balance requirements for firmness and flexibility remains a crucial task within the field of implementation science. [ABSTRACT FROM AUTHOR]

Background: Implementation strategies can help support the adoption and implementation of health interventions that are appropriate for a local context and acceptable to decision makers and community members. Implementation strategies should be designed to handle the complexity of the multi-level, dynamic contexts in which interventions are implemented. Systems science theories and methods explicitly attend to complexity and can be valuable for specifying implementation strategies. Group Model Building (GMB) combines research partner engagement strategies with systems science to support researchers' and partners' learning about complex problems and to identify solutions through consensus. This paper specifies how GMB can operationalize implementation strategies — methods for supporting evidence implementation in real-world practice — and describes how GMB can aid in selecting and tailoring both health interventions and implementation strategies. A case study in child maltreatment prevention planning is provided to illustrate how GMB was used to specify the "actions" — strategy activities — for three implementation strategies (conduct local consensus discussions; build a coalition; model and simulate change) during the earliest implementation phases, with the goal of supporting intervention selection decisions. Examples are provided of generalizable research products that can be produced concurrently through GMB, in addition to contextually-driven implementation support. Methods: Participants (n = 8) were engaged over four sessions using tailored GMB activities. Participants generated a qualitative system dynamics model that described their theory of change for how to prevent child maltreatment in their communities. This theory of change reflected a dynamic understanding of the interconnected determinants of child maltreatment. Results: GMB was acceptable to participants and resulted in products that could be used for implementation planning (e.g., to model and simulate change) and future research. GMB fostered trust and idea sharing between participants. Conclusion: GMB can facilitate learning about which outcomes are (or are not) impacted by interventions, which resources and approaches are required for quality implementation (e.g., implementation strategies), and tradeoffs in outcomes and resources between interventions. GMB also provides a structured, effective process to generate a shared implementation vision amongst participants. Lessons learned include methods for developing trust with and between participants, and the need for researchers to tailor GMB actions for participant and project needs. [ABSTRACT FROM AUTHOR]

Technical assistance (TA) has long been a strategy utilized to support implementation of a range of different evidence-based interventions within clinical, community and other service settings. Great progress has come in extending the evidence base to support TA's use across multiple contexts, the result of more extensive categorizing of implementation strategies to support systematic studies of their effectiveness in facilitating successful implementation. This commentary builds on that progress to suggest several opportunities for future investigation and collaborative activity among researchers, practitioners, policymakers and other key decision-makers in hopes of continuing to build the success highlighted in this special issue and elsewhere. Authors call for increased attention to operationalization and tailoring of TA, considering how TA services can be sustained over time and how to consider externally-provided TA versus that housed within an organization. In addition, the commentary suggests a few key areas for capacity-building that can increase the quality, reach, and impact of TA for the future. [ABSTRACT FROM AUTHOR]

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Background/Objectives: Extensive research has emphasised the persistent challenges and failures in providing hospitalised patients with fundamental evidence-based nursing care, often resulting in grave consequences for patient safety. Recommendations from implementation research indicate that a tailored theory- and research-based implementation strategy targeting contextual determinants can optimise the implementation of evidence-based clinical practice for the benefit of patients. This study evaluated the feasibility of an implementation strategy designed to improve the quality of nursing care by targeting behavioural and environmental barriers in a hospital setting. Methods: Proctor's conceptual model for implementation was applied to evaluate the strategy based on eight outcomes: adoption, acceptability, appropriateness, fidelity, feasibility, penetration, sustainability, and costs. Data collection methods included field observations, informal and focus group interviews, registrations, and audits of electronic patient records. Results: The strategy was adoptive, acceptable, appropriate, and feasible in targeting complex environmental and behavioural determinants (at the individual, team, and management level), enabling successful implementation of fundamental evidence-based nursing care. However, fidelity, feasibility, and sustainability were challenged by competing organisational demands and time constraints. Conclusions: The tailored, multifaceted strategy proved effective in addressing complex environmental and behavioural determinants across multiple levels, facilitating the implementation of fundamental evidence-based nursing care in a clinical practice. Further testing and larger-scale studies is needed to assess the strategy's transferability and its impact on nursing-sensitive patient outcomes in different clinical settings. [ABSTRACT FROM AUTHOR]

Abstract Background Implementation strategies are essential to deliver evidence-based programs that align with local context, resources, priorities, and preferences. However, it is not always clear how specific strategies are selected (vs. others) and strategies are not always operationalized clearly, distinctly, and dynamically. Implementation logic models provide one useful way to conceptualize the role and selection of implementation strategies, plan evaluation of their intended impacts on implementation and effectiveness outcomes, and to communicate key aspects of a project. Methods This paper describes our initial plans, experiences, and lessons learned from applying implementation logic models in the Quadruple Aim Quality Enhancement Research Initiative (QUERI) a large multi-study program funded by the Veterans Health Administration (VA). We began with two primary implementation strategies based on our earlier work (i.e., Iterative RE-AIM and Relational Facilitation) that were applied across three different health outcomes studies. Results Our implementation strategies evolved over time, and new strategies were added. This evolution and reasons for changes are summarized and illustrated with the resulting logic models, both for the overall Quadruple Aim QUERI and the three specific projects. We found that implementation strategies are often not discrete, and their delivery and adaptation is dynamic and should be guided by emerging data and evolving context. Review of logic models across projects was an efficient and useful approach for understanding similarities and differences across projects. Conclusions Implementation logic models are helpful for clarifying key objectives and issues for both study teams and implementation partners. There are challenges in logic model construction and presentation when multiple strategies are employed, and when strategies change over time. We recommend presentation of both original and periodically updated project models and provide recommendations for future use of implementation logic models.

Abstract Background Studies have demonstrated that standardizing labor induction (IOL), often with the use of protocols, may reduce racial inequities in obstetrics. IOL protocols are complex, multi-component interventions. To target identified implementation barriers, audit and feedback (A&F) was selected as an implementation strategy. Here, we aimed to understand the acceptability and effect of A&F on fidelity to this complex intervention through quantitative and qualitative approaches. Methods This secondary analysis of a type I hybrid effectiveness-implementation trial (10/2018–12/2022) compared 2 years before (PRE) to 2 years after (POST) implementation of an IOL protocol at two sites. Fidelity to each of 8 specific protocol components was collected via chart review. During the POST period, unit-aggregated A&F reports were distributed via email every 3 months to site clinicians. Reports tracked fidelity to protocol components over time. For this analysis, we compared component fidelity PRE to POST-implementation. Additionally, during the POST period, we compared fidelity by month after each A&F (Month#1 v. Month#2/3) to evaluate the effect of A&F over time. Acceptability of A&F reports was evaluated using qualitative interviews. Results 8509 labor inductions were included (PRE = 4214, POST = 4295). A&F reports were successfully distributed every 3 months for the 2-year POST period. PRE to POST-implementation, fidelity to 4 of the 8 components increased significantly (cervical Foley utilization, latent labor examination frequency, amniotomy timing, and intrauterine pressure catheter utilization), without change in the other 4 components. For 2 of those 4 components where improvement was noted, there was no difference in fidelity by month after A&F report; rather, there was sustained improvement across the POST-implementation period. On the other hand, for the remaining 2 components, fidelity peaked in the first month after each A&F report, with some decline in the following 2 months prior to the next A&F report. Qualitative analysis (n = 24) supported A&F acceptability, with A&F described as “motivating” and “helpful.” Conclusions A&F was an effective implementation strategy to promote fidelity to certain components of this labor induction protocol. With some decline in effect after the first month POST-A&F report, increased A&F frequency should be considered in future work targeting obstetric outcomes, as well as health inequities.

Background/Objectives: Extensive research has emphasised the persistent challenges and failures in providing hospitalised patients with fundamental evidence-based nursing care, often resulting in grave consequences for patient safety. Recommendations from implementation research indicate that a tailored theory- and research-based implementation strategy targeting contextual determinants can optimise the implementation of evidence-based clinical practice for the benefit of patients. This study evaluated the feasibility of an implementation strategy designed to improve the quality of nursing care by targeting behavioural and environmental barriers in a hospital setting. Methods: Proctor’s conceptual model for implementation was applied to evaluate the strategy based on eight outcomes: adoption, acceptability, appropriateness, fidelity, feasibility, penetration, sustainability, and costs. Data collection methods included field observations, informal and focus group interviews, registrations, and audits of electronic patient records. Results: The strategy was adoptive, acceptable, appropriate, and feasible in targeting complex environmental and behavioural determinants (at the individual, team, and management level), enabling successful implementation of fundamental evidence-based nursing care. However, fidelity, feasibility, and sustainability were challenged by competing organisational demands and time constraints. Conclusions: The tailored, multifaceted strategy proved effective in addressing complex environmental and behavioural determinants across multiple levels, facilitating the implementation of fundamental evidence-based nursing care in a clinical practice. Further testing and larger-scale studies is needed to assess the strategy’s transferability and its impact on nursing-sensitive patient outcomes in different clinical settings.

Abstract Background Health care professionals often fail to adhere to evidence-based guidelines. The implementation of evidence-based methods in health care requires systematic support, but it is still unclear which strategies support professional adherence to clinical practice guidelines. Behavior change techniques can contribute to a more detailed description of implementation strategies. The aim of this scoping review was to explore the nature of studies investigating the sustainability of physiotherapists’ (PTs’) and occupational therapists’ (OTs’) clinical behavior when implementing evidence-based methods in health care. Two research questions were addressed: (1) Which implementation strategies are used in studies that have experienced sustained and unsustained changes in the clinical behavior of PTs and OTs? (2) Which behavior change techniques are used in studies involving sustained and unsustained changes in the clinical behavior of PTs and OTs? Methods The scoping review was carried out in accordance with recommendations and the PRISMA-ScR checklist. Six databases were searched. Studies evaluating changes in the clinical behavior of PTs or OTs before and at least 6 months after the end of an implementation intervention were included. Results A total of 5130 studies were screened, and 29 studies were included. Twenty-one studies reported sustained results, and 8 studies reported unsustained results. The studies reporting sustained clinical behavior used in median 7 implementation strategies, 45% used a 12–24-month implementation support period, and 86% of the interventions were theory-based. Twenty-two implementation strategies were identified among the included studies. Only two of these defined the implementation strategies in terms of behavior change techniques. Conclusions Studies reporting sustained results were characterized by the use of longer implementation periods, more implementation strategies, more theory-based interventions, and more behavior change techniques. Audit and feedback, resources, problem solving, and communities of practice were implementation strategies, and problem solving, demonstration of behavior, and social support were behavior change techniques that were more common in studies with sustained results of PTs’ and OTs’ clinical behavior. Our study also highlights the importance of well-described implementation studies. Registration The protocol for the scoping review has been registered in the Open Science Framework, OSF registry ( https://doi.org/10.17605/OSF.IO/DUYQM ).

Abstract Background Implementation strategies can help support the adoption and implementation of health interventions that are appropriate for a local context and acceptable to decision makers and community members. Implementation strategies should be designed to handle the complexity of the multi-level, dynamic contexts in which interventions are implemented. Systems science theories and methods explicitly attend to complexity and can be valuable for specifying implementation strategies. Group Model Building (GMB) combines research partner engagement strategies with systems science to support researchers’ and partners’ learning about complex problems and to identify solutions through consensus. This paper specifies how GMB can operationalize implementation strategies — methods for supporting evidence implementation in real-world practice — and describes how GMB can aid in selecting and tailoring both health interventions and implementation strategies. A case study in child maltreatment prevention planning is provided to illustrate how GMB was used to specify the “actions” — strategy activities — for three implementation strategies (conduct local consensus discussions; build a coalition; model and simulate change) during the earliest implementation phases, with the goal of supporting intervention selection decisions. Examples are provided of generalizable research products that can be produced concurrently through GMB, in addition to contextually-driven implementation support. Methods Participants (n = 8) were engaged over four sessions using tailored GMB activities. Participants generated a qualitative system dynamics model that described their theory of change for how to prevent child maltreatment in their communities. This theory of change reflected a dynamic understanding of the interconnected determinants of child maltreatment. Results GMB was acceptable to participants and resulted in products that could be used for implementation planning (e.g., to model and simulate change) and future research. GMB fostered trust and idea sharing between participants. Conclusion GMB can facilitate learning about which outcomes are (or are not) impacted by interventions, which resources and approaches are required for quality implementation (e.g., implementation strategies), and tradeoffs in outcomes and resources between interventions. GMB also provides a structured, effective process to generate a shared implementation vision amongst participants. Lessons learned include methods for developing trust with and between participants, and the need for researchers to tailor GMB actions for participant and project needs.

BACKGROUND: School leaders play an integral role in the use of implementation strategies, which in turn support special education teachers in the implementation of evidence-based practices (EBPs). In this convergent mixed methods study, we explored school leaders perceptions of the facilitators and barriers to EBP implementation, particularly for students receiving special education, as well as the importance and feasibility of 15 implementation strategies. METHOD: School leaders (N  =  22, principals, assistant principals, school psychologists, etc.) participated in a semistructured interview that included three parts-qualitative questions, quantitative ratings of strategies importance and feasibility, and discussion of the top three implementation strategies. Data strands were analyzed independently and then integrated to generate meta-inferences. RESULTS: The qualitative data identified facilitators such as access to resources about the intervention (e.g., professional development) and collaboration and teamwork, while barriers centered on lack of school supports, culture/climate, and organizational factors (e.g., lack of communication). The quantitative data indicated that the implementation strategy provide ongoing consultation/coaching was rated as important and feasible. Monitor the progress of the implementation effort was rated as important but less feasible, while conduct educational meetings and change the environment were rated as feasible, but less important. Build partnerships to support implementation was rated as less important and feasible. There was convergence and divergence in mixed methods findings. CONCLUSION: This study underscores the critical need to increase school leaders knowledge and skills related to implementation science to better leverage implementation strategies that address the confluence of relevant implementation determinants.

Abstract Background Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients’ outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment. Methods The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts. Results We documented 226 implementation strategies: 35 ‘foundational’ strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either ‘universal’, consistently used by multiple sites (N = 29), or ‘adaptive’, used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed. Conclusion Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions. Trial registration ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1

Abstract Background Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor’s (2011) implementation outcomes model. Methods Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1. Results Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For “do-ability,” coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures. Conclusions Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed. Trial registration ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016.

Abstract Background Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team’s preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. Methods Study participants included antimicrobial stewardship team members from the nine children’s hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team’s use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. Results 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. Conclusion We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. Trial registration NCT04366440, April 24, 2020.

Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background: Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients' outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment. Methods: The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts. Results: We documented 226 implementation strategies: 35 'foundational' strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either 'universal', consistently used by multiple sites (N = 29), or 'adaptive', used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed. Conclusion: Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions. Trial registration: ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1 [ABSTRACT FROM AUTHOR]

Background: Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor's (2011) implementation outcomes model. Methods: Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1. Results: Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For "do-ability," coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures. Conclusions: Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed. Trial registration: ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016. [ABSTRACT FROM AUTHOR]

Objective: Identify barriers to the adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral healthcare organizations and match these barriers to implementation strategies to inform future implementation efforts. Participants: Twenty behavioral health providers. Design: Qualitative study involving individual, semi-structured interviews regarding barriers to adopting the OSU TBI-ID. Data were thematically analyzed around constructs from the Consolidated Framework for Implementation Research (CFIR). Results were matched to strategies using the Expert Recommendations for Implementing Change (CFIR/ERIC) matching tool. Results: Ten barriers were identified across 4 CFIR domains. Inner-Setting barriers were inadequate leadership engagement, priorities, resources, and organizational incentives. Individual-Characteristics barriers were insufficient knowledge about the connection between TBI and behavioral health and how to conduct the OSU TBI-ID with fidelity, low self-efficacy to conduct screening, and inadequate motivation and buy-in to conduct screening. Outer-Setting barriers were lack of state-level mandates and inadequate incentives to conduct screenings. The Process domain barrier was an insufficient engagement of key personnel. Strategy recommendations include: identify and prepare champions; alter incentive and allowance structures; inform local opinion leaders; build a coalition; access new funding; conduct local consensus discussions; involve executive boards; capture/share local knowledge; conduct educational meetings; assess for readiness and identify determinants; identify early adopters; fund and contract for the clinical innovation; create a learning collaborative; and conduct a local needs assessment. Conclusions: This is the first study to examine barriers to adopting the OSU TBI-ID in real-world practice settings. Our results suggest that multilevel implementation strategies addressing mechanisms of change are necessary at the provider, organizational, and systems levels to overcome the complex barriers affecting TBI screening adoption and implementation. Future research is needed to test these strategies and their mechanisms of action on the adoption, implementation, and sustainment of TBI screening, as well as their effect on client-level outcomes. [ABSTRACT FROM AUTHOR]

Background: There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Methods: Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Results: Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. Conclusions: The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team's preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. Methods: Study participants included antimicrobial stewardship team members from the nine children's hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team's use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. Results: 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. Conclusion: We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. Trial registration: NCT04366440, April 24, 2020. [ABSTRACT FROM AUTHOR]

Background: Champions are integral across research in cancer, yet studies exploring their roles are limited and have produced mixed results. The current review examines and synthesizes descriptions of how champions emerged and the types of activities they most often performed. By examining evidence from across the translational research continuum, this scoping review aims to characterize the role of champions and strategies that facilitate their involvement in the implementation of cancer care interventions in both clinical and community-based settings. Methods: This scoping review was designed and implemented in compliance with PRISMA-ScR. The review focused on peer-reviewed articles in English-language journals. We searched five databases: PubMed (including MEDLINE), Scopus (including EMBASE), CINAHL, PsycINFO, and the Cochrane Library. Articles published from 1971 to 2022 were included. Two members of the team reviewed in duplicate each article and then a single member of the team extracted the data in Covidence, with a second member comparing the extraction to the original article. Qualitative and quantitative data were extracted and then synthesized. These data were used to summarize core champion activities and implementation strategies and to characterize barriers and facilitators to using champions in research. Results: A total of 74 articles were included in the review. The qualitative synthesis highlighted facilitators and barriers to the effective use of champions. Facilitators included consideration of an individual's characteristics when identifying champions, time spent planning for the specific responsibilities of champions, working within a supportive environment, and identifying champions embedded in the target setting. Major barriers included constrained time, low self-efficacy among champions, inadequate training, high turnover rates of champions, and a lack of buy-in from organizational leadership toward the intervention. Champions also were mostly assigned their roles, had varied core activities, and used complementary strategies to empower their target populations. Champions' most frequent core activities include facilitation, outreach/promotion, and recruitment of participants into studies. Conclusions: Champions were used in research of many cancer types and often serve similar roles regardless of where they are located within the translational research process. Despite their critical role, evidence is lacking on the impact of champions specifically on outcomes of many of the research studies that include them. Future research is needed to understand the nuances of champion-driven approaches across diverse cancer care settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Data Sources Methods Results Conclusions Implications for the Profession and/or Patient Care Impact Reporting Method To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.Systematic review.Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full‐text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.No patient or public contribution.Trial Registration: CRD42023413817 [ABSTRACT FROM AUTHOR]

This study aims to develop alternate strategies for completing the creative economy Intellectual Property collateral financing policy so that it may be implemented in Indonesia. The methods used descriptive qualitative research with SWOT analysis to analyze the implementation of Intellectual Property-based financing schemes' supporting and inhibiting factors. The preparation of alternative strategies based on the SWOT matrix produces nine strategies. The nine alternative strategies produced were evaluated and tested using four practical policy analysis criteria: Effectiveness, Efficiency, Legality, and Administrative Robustness. Three primary recommendations emerged from testing alternative approaches: first, a plan to fortify industry regulations related to financial services, which will serve as a model for financial institutions implementing credit provisions based on Intellectual Property collateral and expediting the realization of financing products backed by Intellectual Property Rights. Second, a plan to standard Intellectual Property valuation formula or economic value of Intellectual Property and establish an ecosystem for the Intellectual Property market to promote more consistent Intellectual Property valuations and third, managing credit risk through joint ventures with insurance companies, the debtor will pay the insurance costs that allow the Bank or Financial Institutions to transfer risks to third parties if the Intellectual Property value declines. [ABSTRACT FROM AUTHOR]

This research examines the integration of local wisdom-based green construction practices and their influence on sustainable performance through implementation strategies in the Indonesian construction industry. It focuses on ten construction projects in Bali. The main problem faced is the lack of understanding of the effectiveness of local wisdom-based green construction practices in improving sustainable performance in developing countries. Using the Partial Least Squares Structural Equation Modeling (PLS-SEM) method, data was collected from 200 engineers involved in green construction projects. Results show that local wisdom-based green construction practices significantly influence sustainable performance, both directly (path coefficient 0.290) and indirectly through the mediation of implementation strategies (indirect effect 0.575). The research model shows high explanatory power with R-squared values of 0.802 for Implementation Strategy and 0.831 for Sustainable Performance. These findings indicate that integrating local wisdom in green construction practices when mediated by an effective implementation strategy, can significantly improve the sustainable performance of construction projects. Sustainable waste management was identified as the dominant indicator (loading factor 0.936) of local wisdom-based green construction. In contrast, alignment with government policies and regulations (loading factor 0.925) became critical in the implementation strategy. The results of this study can be applied by project developers, construction managers, and policymakers in designing more effective implementation strategies for integrating local wisdom into green construction practices, considering customizations based on variations in cultural and geographical contexts. [ABSTRACT FROM AUTHOR]

Community partnerships are important for ensuring that school-based research produces knowledge to adequately support the mental health of students, families, and educators. The special issue on university–community partnerships for developing interventions contains an array of studies describing development of both interventions and implementation strategies. These articles have clear relevance to the fields of implementation science and human-centered design, which share similar objectives of promoting the adoption of new innovations. Both disciplines emphasize the adoption of new interventions, iteratively solve real-world problems, consider multiple perspectives, and ultimately focus on individual behavior change. This commentary focuses on the ways that the principles, frameworks, and methods of these two fields relate to one another, the special issue articles, and their orientation toward partnership-driven intervention and implementation strategy development. [ABSTRACT FROM AUTHOR]

Schools need effective, sustainable implementation strategies to support teachers in using effective Tier 1 (i.e., whole class) and Tier 2 (i.e., targeted) behavioral interventions in the classroom. This paper describes an iterative, community-partnered process of developing implementation resources to support teachers in using Tier 1 and 2 positive behavior management interventions; we call these resources the Positive Behavior Management Toolkit (PBMT). There were two key aspects to the iterative development process: 1) working with a Program Development Team of district—and school-employed partners to identify priorities, interpret data, provide feedback on resources, and plan for sustainment; and 2) conducting a series of tryouts in which teachers used a version of the PBMT in their classrooms and provided quantitative and qualitative feedback on acceptability, appropriateness, feasibility, and recommendations for improvement. In partnership with the Program Development Team, we used data from the tryouts to inform revisions to the PBMT. This paper presents quantitative and qualitative data from the tryouts and describes how these data informed revisions to the PBMT. We also describe the processes by which we engaged the team, considerations related to contextual appropriateness, and lessons learned related to community-engaged intervention development research. [ABSTRACT FROM AUTHOR]

Although there are a growing number of implementation strategies to increase the adoption, fidelity, and sustainment of evidence-based practices (EBP), they are often complex and bulky, which can interfere with their widespread application. To address these challenges, the Helping Educational Leaders Mobilize Evidence (HELM) strategy was created as an adaptation of the evidence-based Leadership and Organizational Change for Implementation (LOCI) implementation strategy to enhance elementary school principals' use of strategic implementation leadership to support the adoption and delivery of Tier 1 (i.e., universal social, emotional, and behavioral) EBP. In service of its iterative development, a human-centered design methodology was employed to increase the successful uptake and use of HELM. The Cognitive Walkthrough for Implementation Strategies (CWIS), a novel mixed-methods approach to evaluate implementation strategy usability, was applied to identify and test HELM strategy tasks of critical importance. A sample of 15 elementary school principals participated in group cognitive walkthrough testing as either school principal recipients or HELM coaches. Both user types rated the strategy as acceptable (principal M = 77.8, SD = 15.5; coach M = 87.5, SD = 7.9). Five usability issues were identified using a highly structured common usability issue framework and provided direction for the generation of redesign solutions to be incorporated in a subsequent version of the HELM strategy. The evaluation of the strategy's usability improved its alignment with user needs, expectations, and contextual constraints, rendering a more usable strategy and broadly applicable information surrounding the development of psychosocial implementation strategies in real-world settings. [ABSTRACT FROM AUTHOR]

Le Service Prévision des Crues Vilaine et Côtiers Bretons (SPC VCB) est responsable de la vigilance crues sur les cours d’eau à enjeux de la région Bretagne depuis 2005. Depuis presque 20 ans, les attentes des gestionnaires de crise comme du grand public ont beaucoup évolué, et l’outillage du SPC VCB s’est étoffé. Afin d’observer l’impact du développement des modèles sur la qualité de la prévision, les modèles utilisés actuellement ou précédemment par le SPC VCB ont été classés en trois catégories : statistiques, hydrologiques et hydrauliques. Par la suite, la conformité des points de prévision par rapport aux données observées a été analysée pour chaque année hydrologique. Les données révèlent une diversification des modèles au fil du temps. En 2014, seuls les modèles statistiques étaient représentés. Aujourd’hui 59,7 % des sorties de modèles sont issues d’un modèle statistique, 34 % sont issues d’un modèle hydrologique et 6,3 % sont issues d’un modèle hydraulique. La moyenne de conformité annuelle a constamment augmenté au fil des années, passant de 52,6 % pour la période 2007–2011 à 74,5 % pour la période 2019–2023. Ces stratégies de modélisation ont participé à l’amélioration de la vigilance crues.

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This research aims to analyze alternative strategic priorities in the beef cattle assistance program that can be implemented in Gorontalo Regency. The research was carried out in Gorontalo Regency. The primary and secondary data collected were analyzed using the Analytic Hierarchy Process (AHP) method and descriptive statistics. The research results show that priority alternative strategies in the beef cattle assistance program that can be implemented are: 1) revitalizing the role of extension workers and partner institutions (0.228), 2) increasing business capital and production facilities (0.207), 3) increasing the knowledge and skills capacity of farmers (0.200), 4) strengthening of breeder institutions (0.144), 5) coordination of policymakers (0.131), and 6) distribution of livestock aid on target (0.090). Implementation of the beef cattle assistance program requires 63.7% policy support from the regional government through the Gorontalo Regency Animal Husbandry and Animal Health Service in the form of regulatory support, budget allocation, and intensive and sustainable assistance.

Abstract Background Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated ‘audit and feedback’ with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration ACTRN12622000596707, Protocol version 1.

Teaching research is an effective approach to promoting teachers' professional development. However, the current teaching research is still mainly based on experience-oriented listen-evaluate lessons and collectively prepared lessons, facing difficulties in forming thinking collisions, ensuring the depth of communication, and discovering real teaching problems. In the context of rapid development of intelligent technologies such as big data and cloud computing, the massive amount of educational big data has become an opportunity for the current transformation of school-based teaching research. Teachers can obtain more diverse and comprehensive education data faster or even in real-time, freeing themselves from "experience dependence". With rich data as evidence support, they can find problems in the teaching process, design personalized teaching plans, and then effectively improve teaching practices. Therefore, building a school-based teaching research model enabled by data is considered an effective means to break through the difficulties. Based on this, this paper first affirms the value of teaching research enabled by big data; Secondly, combining the advantages of data enabling, considering the existing technological conditions, and following the operation path of "organization, activity action, and activity evaluation" of the teaching research community, this paper proposes the school-based teaching research model enabled by big data, which is mainly composed of four parts: organization link, action link, evaluation link and external support; Finally, implementation strategies for applying the model in practice are proposed from four aspects: consciousness, ability development, limit control, and system guarantee. It provides the oretical guidance for teachers to carry out evidence-based teaching research activities, promotes the innovative application of teaching research, and fosters the development of practical knowledge for teachers.

Abstract Background Research demonstrates the importance of documenting adaptations to implementation strategies that support integration of evidence-based interventions into practice. While studies have utilized the FRAME-IS [Framework for Reporting Adaptations and Modifications for Implementation Strategies] to collect structured adaptation data, they are limited by a focus on discrete implementation strategies (e.g., training), which do not reflect the complexity of multifaceted strategies like practice facilitation. In this paper, we apply the FRAME-IS to our trial evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology-facilitated team care model for improved hypertension control within a federally qualified health center (FQHC). Methods Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation. Results We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process. Conclusion With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations. Trial registration Clinicaltrials.gov NCT03713515, Registration date: October 19, 2018.

Abstract Background Studies of implementation strategies range in rigor, design, and evaluated outcomes, presenting interpretation challenges for practitioners and researchers. This systematic review aimed to describe the body of research evidence testing implementation strategies across diverse settings and domains, using the Expert Recommendations for Implementing Change (ERIC) taxonomy to classify strategies and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework to classify outcomes. Methods We conducted a systematic review of studies examining implementation strategies from 2010-2022 and registered with PROSPERO (CRD42021235592). We searched databases using terms “implementation strategy”, “intervention”, “bundle”, “support”, and their variants. We also solicited study recommendations from implementation science experts and mined existing systematic reviews. We included studies that quantitatively assessed the impact of at least one implementation strategy to improve health or health care using an outcome that could be mapped to the five evaluation dimensions of RE-AIM. Only studies meeting prespecified methodologic standards were included. We described the characteristics of studies and frequency of implementation strategy use across study arms. We also examined common strategy pairings and cooccurrence with significant outcomes. Findings Our search resulted in 16,605 studies; 129 met inclusion criteria. Studies tested an average of 6.73 strategies (0-20 range). The most assessed outcomes were Effectiveness (n=82; 64%) and Implementation (n=73; 56%). The implementation strategies most frequently occurring in the experimental arm were Distribute Educational Materials (n=99), Conduct Educational Meetings (n=96), Audit and Provide Feedback (n=76), and External Facilitation (n=59). These strategies were often used in combination. Nineteen implementation strategies were frequently tested and associated with significantly improved outcomes. However, many strategies were not tested sufficiently to draw conclusions. Conclusion This review of 129 methodologically rigorous studies built upon prior implementation science data syntheses to identify implementation strategies that had been experimentally tested and summarized their impact on outcomes across diverse outcomes and clinical settings. We present recommendations for improving future similar efforts.

BACKGROUND: Opioid overdose fatalities are preventable with timely administration of naloxone, an opioid antagonist, during an opioid overdose event. Syringe service programs have pioneered naloxone distribution for potential bystanders of opioid overdose. The objective of this study was to pilot test a multi-component implementation strategy-the systems analysis and improvement approach for naloxone (SAIA-Naloxone)-with the goal of improving naloxone distribution by syringe service programs. METHODS: Two syringe service programs participated in a 6-month pilot of SAIA-Naloxone, which included (1) analyzing program data to identify gaps in the naloxone delivery cascade, (2) flow mapping to identify causes of attrition and brainstorm programmatic changes for improvement, and (3) conducting continuous quality improvement to test and assess whether modifications improve the cascade. We conducted an interrupted time series analysis using 52 weeks of data before and 26 weeks of data after initiating SAIA-Naloxone. Poisson regression was used to evaluate the association between SAIA-Naloxone and the weekly number of participants receiving naloxone and number of naloxone doses distributed. RESULTS: Over the course of the study, 11,107 doses of naloxone were distributed to 6,071 participants. Through SAIA-Naloxone, syringe service programs prioritized testing programmatic modifications to improve data collection procedures, proactively screen and identify naloxone-naïve participants, streamline naloxone refill systems, and allow for secondary naloxone distribution. SAIA-Naloxone was associated with statistically significant increases in the average number of people receiving naloxone per week (37% more SPP participants; 95% CI, 12% to 67%) and average number of naloxone doses distributed per week (105% more naloxone doses; 95% CI, 79% to 136%) beyond the underlying pre-SAIA-Naloxone levels. These initial increases were extended by ongoing positive changes over time (1.6% more SSP participants received naloxone and 0.3% more naloxone doses were distributed in each subsequent week compared to the weekly trend in the pre-SAIA Naloxone period). CONCLUSIONS: SAIA-Naloxone has strong potential for improving naloxone distribution from syringe service programs. These findings are encouraging in the face of the worsening opioid overdose crisis in the United States and support testing SAIA-Naloxone in a large-scale randomized trial within syringe service programs.

Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration: ACTRN12622000596707, Protocol version 1. [ABSTRACT FROM AUTHOR]

Background: Studies of implementation strategies range in rigor, design, and evaluated outcomes, presenting interpretation challenges for practitioners and researchers. This systematic review aimed to describe the body of research evidence testing implementation strategies across diverse settings and domains, using the Expert Recommendations for Implementing Change (ERIC) taxonomy to classify strategies and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework to classify outcomes. Methods: We conducted a systematic review of studies examining implementation strategies from 2010-2022 and registered with PROSPERO (CRD42021235592). We searched databases using terms "implementation strategy", "intervention", "bundle", "support", and their variants. We also solicited study recommendations from implementation science experts and mined existing systematic reviews. We included studies that quantitatively assessed the impact of at least one implementation strategy to improve health or health care using an outcome that could be mapped to the five evaluation dimensions of RE-AIM. Only studies meeting prespecified methodologic standards were included. We described the characteristics of studies and frequency of implementation strategy use across study arms. We also examined common strategy pairings and cooccurrence with significant outcomes. Findings: Our search resulted in 16,605 studies; 129 met inclusion criteria. Studies tested an average of 6.73 strategies (0-20 range). The most assessed outcomes were Effectiveness (n=82; 64%) and Implementation (n=73; 56%). The implementation strategies most frequently occurring in the experimental arm were Distribute Educational Materials (n=99), Conduct Educational Meetings (n=96), Audit and Provide Feedback (n=76), and External Facilitation (n=59). These strategies were often used in combination. Nineteen implementation strategies were frequently tested and associated with significantly improved outcomes. However, many strategies were not tested sufficiently to draw conclusions. Conclusion: This review of 129 methodologically rigorous studies built upon prior implementation science data syntheses to identify implementation strategies that had been experimentally tested and summarized their impact on outcomes across diverse outcomes and clinical settings. We present recommendations for improving future similar efforts. [ABSTRACT FROM AUTHOR]

Governments have been promoting policies for fostering innovation and economic growth through processes of digital transformation in different sectors over the last decade. Referring to the Architecture, Engineering, Construction and Operation (AECO) industry, public administrations (PAs) have been trying to comply with legal requirements by exploiting cutting-edge digital tools and innovative methods such as Building Information Modelling (BIM). Compared to traditional methods and technologies, this process can boost project management by increasing collaboration among stakeholders, providing enhanced facility visualisation and reducing errors. Although its strategic benefits are widely recognised, the lack of technical skills and the strong attachment to old standards of operation have hindered its adoption, especially in the Italian context. Thus, there is a great need to push PAs towards a change of mentality and processes and check their adoption. After collecting data through literature review and interviews, this research aims to define an operational framework that supports PAs to implement and check the digitalisation of their workflows for the design phase. The framework consists of three consecutive milestones, including acquisition, modelling and verification. The framework is based on an iterative process, which is in common among the three identified milestones. For each of these milestones, a set of key performance indicators was defined to assess the implementation. Indicators were developed by exploiting five-point-based levels and addressing focal points for implementing digital systems. Taking limits and the BIM maturity level of PAs into account, this step-by-step adoption will help PAs to support BIM implementation and leverage their processes. [ABSTRACT FROM AUTHOR]

Despite the millions of dollars awarded annually by the United States Department of Education to build implementation capacity through technical assistance (TA), data on TA effectiveness are severely lacking. Foundational to the operationalization and consistent research on TA effectiveness is the development and use of standardized TA core competencies, practices, and structures. Despite advances toward a consistent definition of TA, a gap still exists in understanding how these competencies are used within an operationalized set of TA practices to produce targeted outcomes at both individual and organizational levels to facilitate implementation of evidence-based practices. The current article describes key insights derived from the evaluation of an operationalized set of TA practices used by a nationally funded TA center, the State Implementation & Scaling Up of Evidence Based Practices (SISEP) Center. The TA provided by the Center supports the uptake of evidence-based practices in K-12 education for students with disabilities. Lessons learned include: (1) the need to understand the complexities and dependencies of operationalizing TA both longitudinally and at multiple levels of the system (state, regional, local); (2) the relative importance of building general and innovation-specific capacity for implementation success; (3) the value of using a co-design and participatory approach for effective TA delivery; (4) the need to develop TA providers' educational and implementation fluency across areas and levels of the system receiving TA; and (5) the need to ensure coordination and alignment of TA providers from different centers. Gaining an understanding into optimal TA practices will not only provide clarity of definition fundamental to TA research, but it will also inform the conceptual framing and practice of TA. [ABSTRACT FROM AUTHOR]

Background: Research demonstrates the importance of documenting adaptations to implementation strategies that support integration of evidence-based interventions into practice. While studies have utilized the FRAME-IS [Framework for Reporting Adaptations and Modifications for Implementation Strategies] to collect structured adaptation data, they are limited by a focus on discrete implementation strategies (e.g., training), which do not reflect the complexity of multifaceted strategies like practice facilitation. In this paper, we apply the FRAME-IS to our trial evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology-facilitated team care model for improved hypertension control within a federally qualified health center (FQHC). Methods: Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation. Results: We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process. Conclusion: With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations. Trial registration: Clinicaltrials.gov NCT03713515, Registration date: October 19, 2018. [ABSTRACT FROM AUTHOR]

The competitive landscape of modern organizations relies on efficient knowledge utilization and management, underscoring the crucial role of knowledge capture in effective Knowledge Management (KM). This study explores the relationship between knowledge capture, organizational agility, and employee proficiency within KM, pinpointing critical gaps in understanding the optimal utilization of knowledge capture methods within agile-based setups. By addressing these gaps, the study aims to identify effective knowledge capture methods and propose strategies for their seamless integration into agile organizations. The research investigates five hypotheses, affirming the positive impacts of expert interviews, focus groups, interviews, surveys, and questionnaires on the efficiency and effectiveness of knowledge capture processes in agile contexts. Utilizing a mixed-method approach, this study evaluates qualitative and quantitative data derived from interviews and questionnaires. The results highlight the importance of various knowledge capture methods in augmenting the efficiency and efficacy of the knowledge capture process. Additionally, the study outlines implementation strategies customized for each method's application within agile-based organizations. The objective of this research is to provide practical solutions that narrow the disparity between the potential of knowledge capture and the particular needs of agile setups. [ABSTRACT FROM AUTHOR]

BackgroundThere are a growing number of evidence-based interventions (EBIs) for autistic individuals, but few are successfully implemented with fidelity in under-resourced communities and with families from traditionally disenfranchised groups. Implementation science offers tools to increase EBI use in communities, but most implementation strategies are designed specific to a single EBI. It is not feasible to develop a new implementation strategy each time a new EBI is introduced in the community. Therefore, to test the effectiveness and generalizability of implementation strategies we are developing and testing a multifaceted implementation strategy with three EBIs concurrently. The goal of this protocol paper is to describe the randomized field trial of an implementation strategy for use across autism EBIs, diverse settings and participants, with the goal of increasing rapid uptake of effective practices to reach our most vulnerable children.MethodsWe developed a multifaceted implementation strategy called Using Novel Implementation Tools for Evidence-based intervention Delivery (UNITED) to facilitate the implementation and sustainment of three EBIs in under-resourced settings. We will compare fidelity to, and effectiveness of, each intervention [Mind the Gap (MTG), Remaking Recess (RR), Self-Determined Learning Model of Instruction (SDLMI)] with and without UNITED in a randomized field trial. Randomization will be stratified using a minimization allocation method. We will train community practitioners using remote delivery of modules specific to the intervention, and active coaching via Zoom for at least 6 sessions and up to 12 as dictated by each EBI. Our primary outcome is fidelity to each EBI, and our secondary outcome is at the child or family level (family empowerment for MTG, child peer social engagement for RR, and adolescent self-determination for SDLMI, respectively). We will measure progress through the implementation phases using the Stages of Implementation Completion and cost-effectiveness of UNITED.DiscussionThe results of this study will provide rigorous data on the effectiveness and generalizability of one relatively light-touch implementation strategy in increasing use of autism EBIs and associated outcomes in diverse under resourced public service settings for underrepresented autistic youth.Trial registrationMind the Gap: Clinicaltrials.gov Identifier:  NCT04972825 (Date registered July 22, 2021); Remaking Recess: Clinicaltrials.gov Identifier:  NCT04972838 (Date registered July 22, 2021); Self-Determined Learning Model of Instruction: Clinicaltrials.gov Identifier:  NCT04972851 (Date registered July 22, 2021).