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.

Evidence-based Practice Implementation Strategies: Results of a Qualitative Study

2007 ◽  
Vol 44 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Charles A. Rapp ◽  
Diane Etzel-Wise ◽  
Doug Marty ◽  
Melinda Coffman ◽  
Linda Carlson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Evidence Based Practice ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Practice Implementation

scholarly journals Perceptions of the Barriers, Facilitators, Outcomes, and Helpfulness of Strategies to Implement Screening, Brief Intervention, and Referral to Treatment in Acute Care

2021 ◽  
Author(s):  
Alyson Keen ◽  
Kelli M Thoele ◽  
Ukamaka Oruche ◽  
Robin Newhouse
Keyword(s):  
Acute Care ◽  
Brief Intervention ◽  
Qualitative Data ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Clinical Intervention ◽  
Structured Interview ◽  
Evidence Based ◽  
Positive Health

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based clinical intervention used to reduce alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods: Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. This qualitative data was analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 ERIC strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results: All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

Furthering Dissemination and Implementation Research

2017 ◽  
Author(s):  
Lawrence W. Green ◽  
Mona Nasser
Keyword(s):  
Systematic Reviews ◽  
Implementation Research ◽  
External Validity ◽  
Evidence Based Practice ◽  
Internal Validity ◽  
Implementation Process ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Dissemination And Implementation Research

This chapter raises questions about the reliability of much “evidence-based practice” disseminated from the original studies and systematic reviews of those studies, insofar as they were often conducted and reviewed with inadequate attention to external validity. Important issues are raised for dissemination and implementation researchers. Indeed, the pressure on investigators to provide for increasingly rigorous controls on threats to internal validity, and to exclude studies that fall below standards for internal validity, has made many such sources of evidence more suspect in their external validity and less credible to the practitioners or policymakers who would adopt them. Greater attention is needed to ways to incorporate considerations of external validity into studies and in systematic reviews of studies to produce more generalizable evidence, and greater attention to practice-based evidence that can complement the more formal evidence-based practices in the process of implementing and evaluating the dissemination and implementation process

Applying an equity lens to characterizing the process and reasons for an adaptation to an evidenced-based practice

2021 ◽  
Vol 2 ◽  
pp. 263348952110172
Author(s):  
Kelly A Aschbrenner ◽  
Nora M Mueller ◽  
Souvik Banerjee ◽  
Stephen J Bartels
Keyword(s):  
Patient Outcomes ◽  
Mental Health Center ◽  
Implementation Strategies ◽  
Routine Care ◽  
Evidence Based ◽  
Plain Language ◽  
Intervention Component ◽  
Cardiovascular Risk Reduction ◽  
Evidence Based Practices ◽  
National Implementation

Background: Adaptations to evidence-based practices (EBPs) are common but can impact implementation and patient outcomes. In our prior research, providers in routine care made a fidelity-inconsistent adaptation to an EBP that improved health outcomes in people with serious mental illness (SMI). The purpose of this study was to characterize the process and reasons for the adaptation using a framework for reporting adaptations and modifications to EBPs, with a focus on equity. Methods: This study used qualitative data collected during a national implementation of the InSHAPE EBP addressing obesity in persons with SMI. We reviewed transcripts from five behavioral health organizations that made a successful fidelity-inconsistent adaptation to a core component of InSHAPE that was associated with cardiovascular risk reduction. We coded the data using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with an emphasis on exploring whether the adaptation addressed inequities in using the EBP related to social determinants of health. Results: Across the five agencies, the fidelity-inconsistent adaptation was characterized as unplanned and reactive in response to challenges InSHAPE teams experienced delivering the intervention in community fitness facilities as intended. In all cases, the goal of the adaptation was to improve intervention access, feasibility, and fit. Social and economic disadvantage were noted obstacles to accessing fitness facilities or gyms among participants with SMI, which led agencies to adapt the program by offering sessions at the mental health center. Conclusion: Findings from this study show the advantages of applying a health equity lens to evaluate how obstacles such as poverty and discrimination influence EBP adaptations. Recommendations can also assist researchers and community partners in making proactive decisions about allowable adaptations to EBPs. Plain Language Summary Adaptations to evidence-based practices (EBPs) are common but can impact implementation and patient outcomes. Understanding why adaptations are made to EBPs by organizations and providers during implementation can help inform implementation strategies designed to guide adaptations that improve outcomes. We found that social and economic factors were driving inequities in access to a core intervention component of an EBP, which led agencies to adapt an EBP in a way that model developers considered to be inconsistent with fidelity but improved patient outcomes. These findings contribute to the growing literature on equitable implementation and adaptation by highlighting the advantages of considering when and how fidelity-inconsistent adaptations to an EBP may be in the service of reducing inequities in access to and use of EBPs for health disparity groups.

scholarly journals Using organization theory to position middle-level managers as agents of evidence-based practice implementation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sarah A. Birken ◽  
Graeme Currie
Keyword(s):  
Organization Theory ◽  
Evidence Based Practice ◽  
Implementation Strategies ◽  
Middle Level ◽  
Future Research ◽  
Evidence Based ◽  
Different Types ◽  
Recommendations For Practice ◽  
Ebp Implementation ◽  
Practice Implementation

AbstractMiddle-level managers (MLMs; i.e., healthcare professionals who may fill roles including obtaining and diffusing information, adapting information and the intervention, mediating between strategy and day-to-day activities, and selling intervention implementation) have been identified as having significant influence on evidence-based practice (EBP) implementation. We argue that understanding whether and how MLMs influence EBP implementation is aided by drawing upon organization theory. Organization theories propose strategies for increasing MLMs’ opportunities to facilitate implementation by optimizing their appreciation of constructs which we argue have heretofore been treated separately to the detriment of understanding and facilitating implementation: EBPs, context, and implementation strategies. Specifically, organization theory encourages us to delineate different types of MLMs and consider how generalist and hybrid MLMs make different contributions to EBP implementation. Organization theories also suggest that MLMs’ understanding of context allows them to adapt EBPs to promote implementation and effectiveness; MLMs’ potential vertical linking pin role may be supported by increasing MLMs’ interactions with external environment, helping them to understand strategic pressures and opportunities; and how lateral connections among MLMs have the potential to optimize their contribution to EBP implementation as a collective force. We end with recommendations for practice and future research.

Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

ANALISIS VARIASI JUMLAH SUDU TURBIN BERPENAMPANG PELAT DATAR PADA TURBIN AIR ALIRAN VORTEX DENGAN TIPE SALURAN MASUK INVOLUTE

2020 ◽  
Vol 7 (2) ◽  
pp. 72-78
Author(s):  
Adnan Al Farisi ◽  
Yopi Handoyo ◽  
Taufiqur Rokhman
Keyword(s):  
Power Plant ◽  
Alternative Energy ◽  
Vortex Flow ◽  
Experimental Methods ◽  
Turbine Efficiency ◽  
A Value ◽  
Current Voltage ◽  
Materials Research ◽  
The One ◽  
Flow Vortex

The One of alternative energy that is environmentally friendly is by untilize water energy and turn it into a Microhydro power plant. Microhydro power plant usually made from utilize the waterfall with the head fell. While utilization for streams with a head small drop is not optimal yet. This is a reference to doing research on harnessing the flow of a river that has a value of head low between 0.7 m – 1.4 m with turning it into a Vortex flow (vortex). The purpose of this research is to know  the effect variation number of blade on power and efficiency in the vortex turbine. This research uses experimental methods to find current, voltage, torque and rpm using a reading instrument. The materials research vortex turbine used 6 blade, 8 blade and 10 blade with flat plate. The result showed the highest efficiency is 29,93 % with produce turbine power is 19,58 W, generated on turbine with variation 10 blade with load 3,315 kg and the capacity of water 10,14 l/s. Followed with an efficiency 24,17% and produce turbine power is 15,81 W, generated on turbine with the variation 8 blade with load 3,315 kg and the capacity of water is 10,14 l/s. The the lowest turbine efficiency 22,32% with produce tuebine power 14,60 W, generated on turbine with the variation 6 blade with load 3,315 kg, the capacity of water is 10,14 l/s.

Evaluation of the Properties of Humus Liquid of Earthworm Eisenia Foetida Obtained from Different Rachis

2017 ◽  
Vol 3 (02) ◽  
Author(s):  
Ramiro Remigio Gaibor Fernández ◽  
Abraham Adalberto Bayas Zamora ◽  
Galo Israel Muñoz Sánchez ◽  
Cristhian Adrián Rivas Santacruz
Keyword(s):  
Plant Growth ◽  
Fulvic Acids ◽  
Cattle Manure ◽  
Eisenia Foetida ◽  
Humic And Fulvic Acids ◽  
Livestock Manure ◽  
A Value ◽  
The One ◽  
Liquid Slurry

The objective of the present investigation was to evaluate the physical characteristics of the vermicompost and the quality of the purine of the red Californian (Eisenia foetida) using different substrates of feed for these worms. For this purpose, nine treatments were studied: 75% African palm rachis + 25% cattle manure, 50% African palm rachis + 50% cattle manure, 25% African palm rachis + 75% livestock manure, 50% manure of cattle, 50% of manure of cattle, 25% of manure of cattle, 50% of manure of cattle, 50% of manure of cattle, 50% of rach of coconut + 50% of manure of Livestock, 25% coccus rachis + 75% livestock manure. The substrate made up of 50% of rachis of coconut and 50% of livestock manure can be used in nurseries or nurseries for being the one that registered a value of pH 7.3 plus the closest to the neutral compared to the others, besides this (75% of oil palm rachis and 25% of cattle manure) showed a higher content of humic and fulvic acids (0.87 and 0.45 p / p, respectively), compounds that are important for agriculture by stimulating plant growth, in addition to this reflection 0.06% sulfur content, 4.0 ppm boron, 7.0 ppm copper, 47.5 ppm iron, 6.0 ppm manganese, with a presence of microorganisms of the species Trichoderma, Penicillium, Cladosporium sp. in amounts of 1.91x105 UFC / ml, however in this substrate was obtained between 13.3 and 43.5% less liquid slurry in Comparison with other treatments.

Evidence-Based Social Sciences: A New Emerging Field

2018 ◽  
Vol 5 (2) ◽  
pp. 207-211
Author(s):  
Nazila Zarghi ◽  
Soheil Dastmalchian Khorasani
Keyword(s):  
Social Sciences ◽  
Critical Appraisal ◽  
State Of The Art ◽  
Internal Validity ◽  
Evidence Based ◽  
Multiple Sources ◽  
Social Settings ◽  
Research Findings ◽  
Academic Area ◽  
Different Levels

Abstract Evidence based social sciences, is one of the state-of- the-art area in this field. It is making decisions on the basis of conscientious, explicit and judicious use of the best available evidence from multiple sources. It also could be conducive to evidence based social work, i.e a kind of evidence based practice in some extent. In this new emerging field, the research findings help social workers in different levels of social sciences such as policy making, management, academic area, education, and social settings, etc.When using research in real setting, it is necessary to do critical appraisal, not only for trustingon internal validity or rigor methodology of the paper, but also for knowing in what extent research findings could be applied in real setting. Undoubtedly, the latter it is a kind of subjective judgment. As social sciences findings are highly context bound, it is necessary to pay more attention to this area. The present paper tries to introduce firstly evidence based social sciences and its importance and then propose criteria for critical appraisal of research findings for application in society.

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