Evidence-Based Interventions in Schools: Developers’ Views of Implementation Barriers and Facilitators

2008 ◽  
Vol 1 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Susan G. Forman ◽  
S. Serene Olin ◽  
Kimberly Eaton Hoagwood ◽  
Maura Crowe ◽  
Noa Saka
Keyword(s):  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers

Exemplars Illustrating De-implementation of Tradition-Based Practices

2019 ◽  
Vol 39 (6) ◽  
pp. 64-69 ◽  
Author(s):  
Michele J. Upvall ◽  
Annette M. Bourgault ◽  
Cody Pigon ◽  
Christine A. Swartzman
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Clinical Practice ◽  
Cognitive Dissonance ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Complex Process ◽  
Psychological Bias

Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or “sacred cows,” which lack evidence to support their ongoing use. The complex process of discontinuing or reducing the use of tradition-based practices is known as “de-implementation.” Recognizing the importance of de-implementation is necessary to fully understand evidence-based practice. This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.

Implementation Challenges With Evidence-Based Practice Within Inpatient Rehabilitation to Incorporate Task-Specific Training

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512510266p1-7512510266p1
Author(s):  
Eron Bozec ◽  
Namrata Grampurohit ◽  
Jaime Gorska
Keyword(s):  
Implementation Research ◽  
Inpatient Rehabilitation ◽  
Barriers And Facilitators ◽  
Training Manual ◽  
Evidence Based ◽  
Specific Training ◽  
Implementation Barriers ◽  
Study Objective ◽  
Implementation Challenges ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The study objective was to examine the implementation barriers and facilitators after a year of training and use of a task-specific training manual in inpatient rehabilitation. The Consolidated Framework for Implementation Research provided structure for the survey of OTs. Stakeholders reported confidence in evidence incorporation, and the barriers related to ease of selection and use of this intervention need to be addressed. Primary Author and Speaker: Eron Bozec Additional Authors and Speakers: Namrata Grampurohit Contributing Authors: Namrata Grampurohit, Jaime Gorska

scholarly journals Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

2021 ◽  
Author(s):  
J. Edward Murrell ◽  
Janell L. Pisegna ◽  
Lisa A. Juckett
Keyword(s):  
Occupational Therapy ◽  
Scoping Review ◽  
Stroke Rehabilitation ◽  
Implementation Strategies ◽  
Stroke Care ◽  
Barriers And Facilitators ◽  
Educational Outreach ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Implementation Outcomes

Abstract BackgroundEvery year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes. MethodsA scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework. ResultsThe initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes. ConclusionsThis scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

scholarly journals Self-perceived evidence-based practice competencies: a survey of faculty and students at a chiropractic institution*

2019 ◽  
Author(s):  
Anjum S. Odhwani ◽  
Pradip K. Sarkar ◽  
Gene F. Giggleman ◽  
Michelle M. Holmes ◽  
Kathrine A. Pohlman
Keyword(s):  
Student Satisfaction ◽  
Evidence Based Practice ◽  
Cross Sectional Study ◽  
Faculty Members ◽  
The Self ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Cross Sectional ◽  
Ebp Implementation

Objective To assess the self-perceived importance, skills, and utilization of evidence-based practice (EBP) among faculty and students at a chiropractic institution without a structured EBP program. The survey also evaluated EBP satisfaction among students and EBP implementation barriers/facilitators among the faculty. Methods In this cross-sectional study, a set of organized questionnaires to assess the importance of EBP and self-perceived skills, utilization, barriers, and facilitators for faculty members, and student satisfaction was administered to the students and faculty of a chiropractic institution in February–March 2016. Descriptive statistics were used to evaluate responses. Results A total of 417 (60.1%) students and 27 (60.0%) faculty members completed the survey. Faculty members' and students' EBP importance values were similar (8.4 and 8.3 out of 10, respectively), but faculty members self-reported their EBP skills (7.3/10) at a higher level than the student self-reported skill level (6.1/10). For utilization, students reported a higher utilization of EBP than that reported by the responding faculty members. Perceived student satisfaction on the quality and content of research-related experiences decreased from the first year to the third (final) year. Conclusion This study found variance in the self-perceived EBP skills, utilization, barriers, and facilitators and that these skills are lagging at our doctor of chiropractic program, which does not have a structured EBP program. Faculty members and students identified the importance for EBP. Similar observations have been found at other chiropractic institutions prior to their implementation of a systematic EBP program. Those developing an EBP curriculum might use these findings to better design, implement, and assess a structured program.

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

A Process Evaluation of San Francisco’s Law Enforcement Assisted Diversion Program

2021 ◽  
pp. 088740342110333
Author(s):  
Erica Jovanna Magaña ◽  
Dina Perrone ◽  
Aili Malm
Keyword(s):  
Law Enforcement ◽  
San Francisco ◽  
Program Implementation ◽  
Relationship Building ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Diversion Program ◽  
Drug Laws ◽  
Point Of Entry ◽  
Reducing Recidivism

In 2016, San Francisco (SF) implemented the Law Enforcement Assisted Diversion (LEAD) program, a harm reduction–based pre-booking diversion system for people who violate drug laws and/or are engaged in sex work. LEAD is set apart from existing diversion programs, as it uses police as point of entry. Prior LEAD studies indicate some success in reducing recidivism and improving life outcomes. However, less is known about program implementation, including barriers and facilitators. Relying on policy documents, interviews, and focus groups, this study describes the LEAD SF’s development, operations, adaptations, and challenges. It also identifies the unique context of LEAD SF that led to implementation barriers and facilitators. Results show that SF experienced success in collaboration, relationship building, and client connections to services but experienced challenges in securing and maintaining police officer buy-in and keeping clear and open lines of communication regarding LEAD goals, objectives, policies, and procedures. This led to the termination of LEAD SF in 2020.

scholarly journals A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 41-42
Author(s):  
E Johnson ◽  
M Carbonneau ◽  
D Campbell-Scherer ◽  
P Tandon ◽  
A Hyde
Keyword(s):  
Focus Groups ◽  
Gastrointestinal Disease ◽  
Pragmatic Trial ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Care Utilization ◽  
Implementation Barriers ◽  
Mortality And Morbidity ◽  
Order Set

Abstract Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates

scholarly journals Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

2015 ◽  
Vol 95 (4) ◽  
pp. 588-599 ◽  
Author(s):  
Joel M. Stevans ◽  
Christopher G. Bise ◽  
John C. McGee ◽  
Debora L. Miller ◽  
Paul Rockar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Report ◽  
Physical Therapy ◽  
Care Quality ◽  
Routine Practice ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Improvement Program ◽  
Improvement Project ◽  
Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

scholarly journals Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

2021 ◽  
pp. 104973232199344
Author(s):  
Oladunni Oluwoye ◽  
Elizabeth Fraser
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Theoretical Domains Framework ◽  
First Episode Psychosis ◽  
Barriers And Facilitators ◽  
First Episode ◽  
Evidence Based ◽  
Behavior Change Techniques ◽  
Episode Psychosis ◽  
And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

Unfolding and characterizing the barriers and facilitators of scaling-up evidence-based interventions from the stakeholders’ perspective

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Xiaoyan Zhang ◽  
Junqiang Zhao ◽  
XueJing Li ◽  
Lijiao Yan ◽  
Yufang Hao ◽  
...  
Keyword(s):  
Scaling Up ◽  
Barriers And Facilitators ◽  
Evidence Based
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