scholarly journals Refining contextual inquiry to maximize generalizability and accelerate the implementation process

2021 ◽  
Vol 2 ◽  
pp. 263348952199494
Author(s):  
Molly Davis ◽  
Rinad S Beidas
Keyword(s):  
Best Practices ◽  
Behavioral Health ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Plain Language ◽  
Scientific Rigor ◽  
Implementation Context ◽  
Practice Gap ◽  
Scaling Out

Background: While contextual inquiry, or in-depth mixed-methods work to study the implementation context, is critical for understanding the setting in which a behavioral health evidence-based practice (EBP) will be implemented, current methods to determine potential barriers and facilitators to implementation are often conducted in a single setting and/or for a single EBP per study, often taking 1–2 years to complete. To maximize generalizability and reduce the research-to-practice gap efficiently, it is important to move toward cross-sector and/or cross-EBP contextual inquiry. Methods: In this viewpoint, we argue for (a) collaborative research studies that seek to identify determinants of implementation that are similar and unique across different settings and EBPs, using rapid approaches when possible; (b) enhanced synthesis of existing research on implementation determinants to minimize duplication of contextual inquiry efforts; and (c) clear rationale for why additional in-depth or rapid contextual inquiry is needed before it is conducted. Throughout this viewpoint, the need to balance scientific rigor and speed are considered. Conclusions: Overall, this viewpoint seeks to encourage researchers to consolidate and share knowledge on barriers and facilitators to implementation to prepare for the scaling out of much needed implementation strategies and interventions for improving health. Plain language summary: Significant time and resources are often devoted to understanding what makes it easier or harder to use best practices for behavioral health concerns in health care settings. The goal of the current viewpoint is to offer ways to streamline this process so that high-quality behavioral health services can reach the patients that need them more quickly. In particular, we advocate for ways to share knowledge among researchers and learn from prior findings to more efficiently identify what makes it easier or harder to use best practices for addressing behavioral health problems in a given setting (e.g., primary care, schools, specialty mental health).

scholarly journals Barriers and Facilitators in the Strengthening Families Program (SFP 10–14) Implementation Process in Northeast Brazil: A Retrospective Qualitative Study

2020 ◽  
Vol 17 (19) ◽  
pp. 6979 ◽  
Author(s):  
Ingrid Gomes Abdala ◽  
Sheila Giardini Murta ◽  
Jordana Calil Lopes de Menezes ◽  
Larissa de Almeida Nobre-Sandoval ◽  
Maria do Socorro Mendes Gomes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Preventive Program ◽  
Public Agency ◽  
Intervention Delivery ◽  
Vulnerable Families ◽  
Strengthening Families Program ◽  
Strengthening Families

This study analyzed contextual barriers and facilitators in the implementation of Strengthening Families Program (SFP 10–14), Brazilian version, a family-based preventive program focused on the prevention of risk behaviors for adolescent health. SFP 10–14 was implemented between 2016 and 2017 for socioeconomically vulnerable families in four Northeast Brazilian states as a tool of the National Drug Policy. A retrospective qualitative study was carried out in which 26 implementation agents participated. Data from 16 individual interviews and two group interviews were analyzed through content analysis. The most recurrent barriers were the group facilitators’ working conditions, weak municipal administration, precarious infrastructure, inadequate group facilitator training methodologies, low adherence of managers and professionals, and funding scarcity. The conditions highlighted as favorable to the implementation were proper intersectoral coordination, engagement of involved actors, awareness of public agency administrators, municipal management efficacy, and efficient family recruitment strategies. Favorable political contexts, engagement of implementation agents, and intersectoral implementation strategies were identified as central to the success of the implementation of SFP 10–14, especially in the adoption of the intervention, community mobilization, and intervention delivery stages. Further studies should combine contexts, mechanisms, and results for a broad understanding of the effectiveness of this intervention in the public sector.

scholarly journals Implementation analysis of patient reported outcomes (PROs) in oncological routine care: an observational study protocol

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirja Gianna Görlach ◽  
Theresa Schrage ◽  
Carsten Bokemeyer ◽  
Nicolaus Kröger ◽  
Volkmar Müller ◽  
...  
Keyword(s):  
Observational Study ◽  
Patient Care ◽  
Cancer Care ◽  
Medical Staff ◽  
Patient Reported Outcomes ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Routine Care ◽  
Barriers And Facilitators ◽  
Patient Reported

Abstract Background The successful implementation of patient-reported outcomes (PROs) in clinical routine faces many challenges, first and foremost the lack of consideration thereof in the patient care process. The aim of this study will be to first identify relevant barriers and facilitators and then design suitable implementation strategies which will be evaluated to improve the effectiveness of a PRO measure assessment in inpatient and outpatient cancer routine care. Methods During the preparation phase, interviews with oncological patients (N = 28) and medical staff (N = 4) as well as focus groups with medical staff (N = 18) across five different departments caring for cancer patients were conducted. On the basis of these, qualitative content analysis revealed relevant barriers and facilitators for implementation of PROs in cancer care. Subsequently, implementation strategies and a model of implementation were developed. In the study phase, implementation strategies will be evaluated based on nine different implementation outcomes in five different oncological clinics. Evaluation of the implementation process will take place during three months in each clinic and data will be conducted pre, while and post implementation of the PRO measure. Therefore a sample size of 60 participants of whom 30 staff members and 30 participants will be questioned using existing and newly developed implementation outcome evaluation instruments. Discussion Key to improving the effectiveness of PRO assessment in the time-critical clinical environment is the utilization of easy-to-use, electronic PRO questionnaires directly linked to patients’ records thereby improving consideration of PROs in patient care. In order to validate the effectiveness of this implementation process further, an evaluation parallel to implementation following an observational study design with a mixed-methods approach will be conducted. This study could contribute to the development of adequate evaluation processes of implementation of PROs to foster sustainable integration of PRO measures into routine cancer care. Trial registration This study was registered at Open Science Framework (https://osf.io/y7xce/).

Barriers and facilitators to integrating behavioral health services and pediatric primary care.

2020 ◽  
Author(s):  
Keri J. S. Brady ◽  
Michelle P. Durham ◽  
Alex Francoeur ◽  
Cameron Henneberg ◽  
Avanti Adhia ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Behavioral Health ◽  
Barriers And Facilitators ◽  
Pediatric Primary Care ◽  
Behavioral Health Services

Evidence-based eHealth interventions for caregivers of people with dementia (Myinlife and Partner in Balance): Evaluation of implementations in municipality contexts (Preprint)

2020 ◽  
Author(s):  
Hannah Liane Christie ◽  
Lizzy Mitzy Maria Boots ◽  
Huibert Johannes Tange ◽  
Frans Rochus Josef Verhey ◽  
Marjolein Elizabeth de Vugt
Keyword(s):  
Self Efficacy ◽  
Measurement Instrument ◽  
Implementation Process ◽  
Successful Implementation ◽  
Evidence Based ◽  
Multiple Sources ◽  
Target Groups ◽  
Face To Face ◽  
People With Dementia ◽  
Implementation Context

BACKGROUND Very few evidence-based eHealth interventions for caregivers of people with dementia are implemented into practice. Municipalities are one promising context to implement these interventions, due to their available policy and innovation incentives regarding (dementia) caregiving and prevention. In this study, two evidence-based eHealth interventions for caregivers of people with dementia (Partner in Balance and Myinlife) were implemented in eight municipalities in the Euregion Meuse-Rhine. OBJECTIVE This study’s objectives were to (1.) evaluate this implementation and (2.) investigate determinants of successful implementation. METHODS This study collected eHealth usage data, Partner in Balance coach evaluation questionnaires, and information on implementation determinants. This was done by conducting interviews with the municipality officials, based on the Measurement Instrument for Determinants of Implementation (MIDI). This data from multiple sources and perspectives was integrated and analysed to form a total picture of the municipality implementation process. RESULTS The municipality implementation of Partner in Balance and Myinlife showed varying levels of success. In the end, three municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. The two Partner in Balance municipalities that did not consider the implementation to be successful, viewed the implementation as an external project. For Myinlife, it was clear that more face-to-face contact was needed to engage the implementing municipality and the target groups. Successful implementations were linked to implementer self-efficacy CONCLUSIONS The experiences of implementing these interventions suggested that this implementation context was feasible regarding the required budget and infrastructure. The need to foster sense of ownership and self-efficacy in implementers will be integrated into future implementation protocols, as part of standard implementation materials for municipalities and organisations implementing Myinlife and Partner in Balance.

scholarly journals Barriers to implementing motivational interviewing in addiction treatment: A nominal group technique process evaluation

2021 ◽  
Vol 2 ◽  
pp. 263348952110184
Author(s):  
Melissa R Hatch ◽  
Kristine Carandang ◽  
Joanna C Moullin ◽  
Mark G Ehrhart ◽  
Gregory A Aarons
Keyword(s):  
Motivational Interviewing ◽  
Process Evaluation ◽  
Nominal Group Technique ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Nominal Group ◽  
Management Level ◽  
Implementation Program ◽  
Ebp Implementation ◽  
Staff Level

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods: This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders’ perceptions of each barrier’s influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results: Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion: EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness. Plain Language Summary Unforeseen barriers often arise during the course of implementation. Conducting evaluations during implementation allows for tailoring the implementation strategy. As part of a larger study using the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI), we collected data from the first cohort of LOCI clinic leaders to identify barriers to MI implementation that persisted despite advanced planning and to understand unanticipated barriers that arose during implementation. Leaders identified 15 barriers faced during the implementation process that fell into three categories: staff-level barriers, management-level barriers, and implementation program barriers. The leaders ranked time as the most influential barrier at both the staff and management levels. Staff apprehension, resistance to MI implementation, and staff turnover were also of significant concern to leaders. Future implementation efforts may benefit from conducting a similar process evaluation during the implementation phase.

Implementation aspects of agile methods in large organizations

e-mentor ◽  
2021 ◽  
Vol 90 (3) ◽  
pp. 64-72
Author(s):  
Robert Pawlak ◽  
Keyword(s):  
Best Practices ◽  
Large Scale ◽  
Success Factors ◽  
Implementation Process ◽  
Business Practice ◽  
Organization Culture ◽  
Agile Methods ◽  
Implementation Challenges ◽  
Depth Analysis ◽  
Implementation Aspects

The aim of this article is to analyze the challenges and success factors on organizations’ path to agile transformation, as frequently discussed in the literature and encountered in business practice. The research conducted proved that large-scale agile transformations require a dedicated approach with set of tools and best practices in place. The implementation challenges and barriers have been categorized into method-, organization-, culture- and technology-oriented groups. As a result of an in-depth analysis carried on for the purpose of this paper, a dedicated methodology of agile transformation has been proposed to ease the implementation process.

scholarly journals The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ulrica von Thiele Schwarz ◽  
Gregory A. Aarons ◽  
Henna Hasson
Keyword(s):  
Patient Outcomes ◽  
Theoretical Approach ◽  
Internal Validity ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Evidence Based ◽  
A Value ◽  
The One ◽  
Practice Implementation ◽  
Fidelity And Adaptation

Abstract Background There has long been debate about the balance between fidelity to evidence-based interventions (EBIs) and the need for adaptation for specific contexts or particular patients. The debate is relevant to virtually all clinical areas. This paper synthesises arguments from both fidelity and adaptation perspectives to provide a comprehensive understanding of the challenges involved, and proposes a theoretical and practical approach for how fidelity and adaptation can optimally be managed. Discussion There are convincing arguments in support of both fidelity and adaptations, representing the perspectives of intervention developers and internal validity on the one hand and users and external validity on the other. Instead of characterizing fidelity and adaptation as mutually exclusive, we propose that they may better be conceptualized as complimentary, representing two synergistic perspectives that can increase the relevance of research, and provide a practical way to approach the goal of optimizing patient outcomes. The theoretical approach proposed, the “Value Equation,” provides a method for reconciling the fidelity and adaptation debate by putting it in relation to the value (V) that is produced. The equation involves three terms: intervention (IN), context (C), and implementation strategies (IS). Fidelity and adaptation determine how these terms are balanced and, in turn, the end product – the value it produces for patients, providers, organizations, and systems. The Value Equation summarizes three central propositions: 1) The end product of implementation efforts should emphasize overall value rather than only the intervention effects, 2) implementation strategies can be construed as a method to create fit between EBIs and context, and 3) transparency is vital; not only for the intervention but for all of the four terms of the equation. Summary There are merits to arguments for both fidelity and adaptation. We propose a theoretical approach, a Value Equation, to reconciling the fidelity and adaptation debate. Although there are complexities in the equation and the propositions, we suggest that the Value Equation be used in developing and testing hypotheses that can help implementation science move toward a more granular understanding of the roles of fidelity and adaptation in the implementation process, and ultimately sustainability of practices that provide value to stakeholders.

scholarly journals Information and communication technology-based interventions for suicide prevention implemented in clinical settings: A scoping review protocol

2021 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Juveria Zaheer ◽  
Terri Rodak ◽  
John Torous ◽  
Gillian Strudwick
Keyword(s):  
Information And Communication Technology ◽  
Suicide Prevention ◽  
Communication Technology ◽  
Scoping Review ◽  
Implementation Strategies ◽  
Mobile App ◽  
Barriers And Facilitators ◽  
Clinical Settings ◽  
Scoping Reviews ◽  
Information And Communication

IntroductionThere is a surplus of Information and Communication Technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognize the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multi-phase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterize ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterize the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximize implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings.Methods and analysis This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. The following databases will be searched: Medline, PsycInfo, Embase, CINAHL, Web of Science, and LISTA. Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterize extracted data using frameworks, typology, and taxonomies to address the proposed review questions. Ethics and disseminationEthics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication, and conference presentations. Furthermore, the findings will be shared with relevant health organizations through lay language summaries and informal presentations.

National Goals for Supporting Families Across the Life Course

Inclusion ◽  
2015 ◽  
Vol 3 (4) ◽  
pp. 260-266 ◽  
Author(s):  
Michelle C. Reynolds ◽  
George S. Gotto ◽  
Catherine Arnold ◽  
Thomas L. Boehm ◽  
Sandra Magaña ◽  
...  
Keyword(s):  
Best Practices ◽  
Life Course ◽  
Implementation Strategies ◽  
The United States ◽  
Intellectual And Developmental Disabilities ◽  
Policy And Practice ◽  
Family Structures ◽  
The Family ◽  
Support Practices ◽  
The Life Course

Abstract As a core unit of our society, the family provides support for all its members. Due to the nature of their disabilities, people with intellectual and developmental disabilities (IDD) often receive emotional, physical, and material support from their families across the life course. During the National Goals 2015 Conference, three goals were identified that will lead to a better understanding of families and maximize their capacity, strengths, and unique abilities to support, nurture, and facilitate opportunities for family members who have a disability. The three goals are to (1) develop a better understanding of the complex family structures in the United States and the best practices for supporting them; (2) extend our knowledge on how families are or might be supported by their natural communities, outside the purview of IDD systems; and (3) synthesize support practices, implementation strategies, and outcomes for supporting families. This article describes these three goals related to supporting families across the life course and provides a rationale, areas of research to address the goals, and implications for policy and practice for each goal.

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